Advertisement

Rheumatology International

, Volume 37, Issue 7, pp 1065–1073 | Cite as

Vascular surgery: the main risk factor for mortality in 146 Takayasu arteritis patients

  • Nilton Salles Rosa Neto
  • Samuel Katsuyuki Shinjo
  • Maurício Levy-Neto
  • Rosa Maria Rodrigues PereiraEmail author
Safety

Abstract

Takayasu arteritis (TA) is an idiopathic chronic inflammatory disease that affects the aorta and its main branches. According to disease involvement, patients may require surgical treatment mainly due ischemic lesions in association with medical therapy. We evaluated the impact of vascular interventions in a cohort of TA patients. Medical records from 146 TA patients were reviewed. Clinical features, medical, and surgical treatment were revised and disease activity was determined by clinical, laboratorial, and imaging parameters. Clinical parameters associated with mortality alongside vascular procedures were evaluated and their impact on mortality in our cohort was estimated. Ninety-four vascular interventions were performed in 61 patients (41.8%). A third of them were of endovascular procedures. The overall mortality was 4.1%, all due to early postoperative complications, which resulted in a rate of surgery-related mortality of 9.8%. All deaths occurred in patients with active disease. Clinical parameters known to be associated with mortality (aneurysm, secondary hypertension, aortic insufficiency, and cerebrovascular accident) were not found related with death. Patients whose disease began before age 20 years had an OR 3.54 of undergoing a vascular surgical intervention. The observed impact of vascular procedures on mortality in patients with Takayasu arteritis, especially during disease activity, supports the notion that such interventions should be performed with caution and preferably during periods of remission.

Keywords

Takayasu arteritis Vascular surgery Epidemiology Vasculitis Mortality 

Notes

Compliance with ethical standards

Conflict of interest

Rosa Neto NS, Shinjo SK, Levy-Neto M and Pereira RMR declare that they have no conflict of interest.

References

  1. 1.
    Subramanyan R, Joy J, Balakrishnan KG (1989) Natural history of aortoarteritis (Takayasu’s disease). Circulation 80(3):429–437CrossRefPubMedGoogle Scholar
  2. 2.
    Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M et al (1994) Takayasu arteritis. Ann Intern Med 120:919–929CrossRefPubMedGoogle Scholar
  3. 3.
    Dong H, Jiang X, Peng M, Zou Y, Guan T, Zhang H et al (2014) Percutaneous transluminal angioplasty for symptomatic pulmonary stenosis in Takayasu arteritis. J Rheumatol 41(9):1856–1862CrossRefPubMedGoogle Scholar
  4. 4.
    Ishikawa K (1978) Natural history and classification of occlusive thromboaortopathy (Takayasu’s disease). Circulation 57(1):27–35CrossRefPubMedGoogle Scholar
  5. 5.
    Ishikawa K, Maetani S (1994) Long-term outcome for 120 Japanese patients with Takayasu’s disease. Clinical and statistical analyses of related prognostic factors. Circulation 90(4):1855–1860CrossRefPubMedGoogle Scholar
  6. 6.
    Ohigashi H, Haraguchi G, Konishi M, Tezuka D, Kamiishi T, Ishihara T et al (2012) Improved prognosis of Takayasu arteritis over the past decade — comprehensive analysis of 106 patients. Circ J 76(4):1004–1011CrossRefPubMedGoogle Scholar
  7. 7.
    Miyata T, Sato O, Koyama H, Shigematsu H, Tada Y (2003) Long-term survival after surgical treatment of patients with Takayasu’s Arteritis. Circulation 108:1474–1480CrossRefPubMedGoogle Scholar
  8. 8.
    Keser G, Direskeneli H, Aksu K (2014) Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 53(5):793–801CrossRefPubMedGoogle Scholar
  9. 9.
    Miyata T (2014) The Asia Pacific meeting for vasculitis and ANCA workshop 2012: surgical treatment for Takayasu’s arteritis. Clin Exp Nephrol 18(2):296–300CrossRefPubMedGoogle Scholar
  10. 10.
    Johnston SL, Lock RJ, Gompels MM (2002) Takayasu arteritis: a review. J Clin Pathol 55(7):481–486CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lee BB, Laredo J, Neville R, Villavicencio JL (2009) Endovascular management of takayasu arteritis: is it a durable option? Vascular 17(3):138–146CrossRefPubMedGoogle Scholar
  12. 12.
    Borg FA, Dasgupta B (2009) Treatment and outcomes of large vessel arteritis. Best Pract Res Clin Rheumatol 23(3):325–337CrossRefPubMedGoogle Scholar
  13. 13.
    Sharma S, Gupta A (2009) Visceral artery interventions in Takayasu arteritis. Semin Interv Radiol 26(3):233–244CrossRefGoogle Scholar
  14. 14.
    Mason JC (2015) Takayasu arteritis: surgical interventions. Curr Opin Rheumatol 27(1):45–52CrossRefPubMedGoogle Scholar
  15. 15.
    Fields CE, Bower TC, Cooper LT, Hoskin T, Noel AA, Panneton JN et al (2006) Takayasu’s arteritis: operative results and influence of disease activity. J Vasc Surg 43(1):64–71CrossRefPubMedGoogle Scholar
  16. 16.
    Bezerra MC, Calomeni GD, Caparbo VF, Gebrim ES, Rocha MS, Pereira RM (2005) Low bone density and low serum levels of soluble RANK ligand are associated with severe arterial calcification in patients with Takayasu arteritis. Rheumatology 44:1503–1506CrossRefPubMedGoogle Scholar
  17. 17.
    Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol 1996(54 Suppl):S155–S163Google Scholar
  18. 18.
    Kim YW, Kim DI, Park YJ, Yang SS, Lee GY, Kim DK et al (2012) Surgical bypass vs endovascular treatment for patients with supra-aortic arterial occlusive disease due to Takayasu arteritis. J Vasc Surg 55(3):693–700CrossRefPubMedGoogle Scholar
  19. 19.
    Tann OR, Tulloh RM, Hamilton MC (2008) Takayasu’s disease: a review. Cardiol Young 18(3):250–259CrossRefPubMedGoogle Scholar
  20. 20.
    Park HS, Do YS, Park KB, Kim DK, Choo SW, Shin SW et al (2013) Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: angioplasty versus stent placement. Eur J Radiol 82(11):1913–1918CrossRefPubMedGoogle Scholar
  21. 21.
    Lee GY, Jeon P, Do YS, Sung K, Kim DI, Kim YW et al (2014) Comparison of outcomes between endovascular treatment and bypass surgery in Takayasu arteritis. Scand J Rheumatol 43(2):153–161CrossRefPubMedGoogle Scholar
  22. 22.
    Ham SW, Kumar SR, Rowe VL, Weaver FA (2011) Disease progression after initial surgical intervention for Takayasu arteritis. J Vasc Surg 54(5):1345–1351CrossRefPubMedGoogle Scholar
  23. 23.
    Joseph G (2013) L49. Percutaneous interventions in Takayasu arteritis. Presse Med 42(4 Pt 2):635–637CrossRefPubMedGoogle Scholar
  24. 24.
    Jales-Neto LH, Levy-Neto M, Bonfa E, de Carvalho JF, Pereira RM (2010) Juvenile-onset Takayasu arteritis: peculiar vascular involvement and more refractory disease. Scand J Rheumatol 39(6):506–510CrossRefPubMedGoogle Scholar
  25. 25.
    Clemente G, Hilário MO, Len C, Silva CA, Sallum AM, Campos LM et al (2016) Brazilian multicenter study of 71 patients with juvenile-onset Takayasu’s arteritis: clinical and angiographic features. Rev Bras Reumatol Engl Ed 56(2):145–151CrossRefPubMedGoogle Scholar
  26. 26.
    Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P et al (2012) Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation 125(6):813–819CrossRefPubMedGoogle Scholar
  27. 27.
    Mwipatayi BP, Jeffery PC, Beningfield SJ, Matley PJ, Naidoo NG, Kalla AA et al (2005) Takayasu arteritis: clinical features and management: report of 272 cases. ANZ J Surg 75(3):110–117CrossRefPubMedGoogle Scholar
  28. 28.
    Kaku Y, Aomi S, Tomioka H, Yamazaki K (2015) Surgery for aortic regurgitation and aortic root dilatation in Takayasu arteritis. Asian Cardiovasc Thorac Ann 23(8):901–906CrossRefPubMedGoogle Scholar
  29. 29.
    Muranjan MN, Bavdekar SB, More V, Deshmukh H, Tripathi M, Vaswani R (2000) Study of Takayasu’s arteritis in children: clinical profile and management. J Postgrad Med 46(1):3–8PubMedGoogle Scholar
  30. 30.
    Schmidt J, Kermani TA, Bacani AK, Crowson CS, Cooper LT, Matteson EL et al (2013) Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients. Mayo Clin Proc 88(8):822–830CrossRefPubMedGoogle Scholar
  31. 31.
    Perera AH, Youngstein T, Gibbs RG, Jackson JE, Wolfe JH, Mason JC (2014) Optimizing the outcome of vascular intervention for Takayasu arteritis. Br J Surg 101(2):43–50CrossRefPubMedGoogle Scholar
  32. 32.
    Labarca C, Makol A, Crowson CS, Kermani TA, Matteson EL, Warrington KJ (2016) Retrospective comparison of open versus endovascular procedures for Takayasu arteritis. J Rheumatol 43(2):427–432CrossRefPubMedGoogle Scholar
  33. 33.
    Li J, Zhu M, Li M, Zheng W, Zhao J, Tian X et al (2016) Cause of death in Chinese Takayasu arteritis patients. Medicine (Baltimore) 95(27):e4069CrossRefGoogle Scholar
  34. 34.
    Serra R, Butrico L, Fugetto F, Chibireva MD, Malva A, De Caridi G et al. Updates in pathophysiology, diagnosis and management of Takayasu arteritis. Ann Vasc Surg 35:210–225. doi: 10.1016/j.avsg.2016.02.011

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Nilton Salles Rosa Neto
    • 1
  • Samuel Katsuyuki Shinjo
    • 1
  • Maurício Levy-Neto
    • 1
  • Rosa Maria Rodrigues Pereira
    • 1
    Email author
  1. 1.Division of Rheumatology, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil

Personalised recommendations