Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis
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Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4–53.8) months, while four (57%) had clinical improvement after 11.8 (0.2–29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.
KeywordsBehçet disease Vasculitis Aortitis Abdominal aortic aneurysm Endovascular stent Surgical graft interposition
All of the authors participated sufficiently in the work to take public responsibility for appropriate portions of the content; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, according to the updated ICMJE authorship criteria in December 2018. Specifically, TS participated in the conceptual design of the study, acquisition and analysis of data and analyzed the data, and involved in the drafting of the manuscript; BAE involved in the acquisition and analysis of data, critically revised the manuscript; MA and MK involved in the endovascular treatments, analysis and interpretation of data, and critically revised the manuscript; AP participated in the endovascular treatments, analyzed and critically interpreted all radiological data, and critically revised the manuscript; AG conceptually designed and coordinated the study, critically analyzed and interpreted the data, edited and revised the manuscript. All authors read and approved the final version of the manuscript.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
AG received honoraria from Servier, AbbVie, MSD and Novartis and research grants from Xoma and Novartis. The author TS declares that he has no conflict of interest. The author BAE declares that she has no conflict of interest. The author MA declares that he has no conflict of interest. The author MK declares that he has no conflict of interest. The author AP declares that she has no conflict of interest.
The Ethics Committee of Istanbul Faculty of Medicine approved the study protocol (2012/764–1063 on 27 April 2012) and allowed the retrospective analysis of available records of the patients followed up in the outpatient clinic between 1988 and 2011.
All procedures performed in this study in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of XYZ approved the study protocol (2012/764–1063 on 27 April 2012) and allowed the retrospective analysis of available records of the patients followed up in the outpatient clinic between 1988 and 2011. The Ethics Committee also consented to use the radiographic images without any identification if it is not possible to get permission from died patients or their next of kin. Patients gave written consent for being participated in the study and using their data and radiographic images. Next of kin of two died patients could not be traced, and their images were used without any identification with the approval of local ethics committee.
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