Management and prognosis of nonpulmonary large arterial disease in patients with Behçet disease

• Published in: Journal of vascular surgery Vol. 55; no. 1; pp. 157 - 163
• Main Authors: Tuzun, Hasan, MD, Seyahi, Emire, MD, Arslan, Caner, MD, Hamuryudan, Vedat, MD, Besirli, Kazim, MD, Yazici, Hasan, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 2012; Elsevier
• Subjects: Adult; Anastomosis, Surgical; Aneurysm - diagnosis; Aneurysm - etiology; Aneurysm - surgery; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - surgery; Atherosclerosis (general aspects, experimental research); Behcet Syndrome - complications; Behcet Syndrome - drug therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Endarterectomy, Carotid; Female; Graft Occlusion, Vascular - etiology; Humans; Immunosuppressive Agents - therapeutic use; Ligation; Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Recurrence; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Turkey; Ultrasonography, Doppler; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Turkey; Human; Skin disease; Prognosis; Stomatology; Cardiovascular disease; Behçet syndrome; Genital diseases; Vascular disease; Arterial disease; Arteriopathy; Eye disease; Vasculitis; Clinical management; Surgery; Systemic disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.07.049

Objective The purpose of this study was to evaluate and report our treatment policies in the management of nonpulmonary arterial aneurysms in Behçet disease and to assess the prognosis in a cohort of 25 patients diagnosed between 1996 and 2007 by formally reassessing their outcome at the present time. Methods We identified 25 patients (24 men/1 woman) with Behçet disease with nonpulmonary aneurysms (n = 23) or occlusions (n = 2) between 1996 and 2007. All patients fulfilled the International Study Group Criteria for Behçet disease. Aneurysms were demonstrated with contrast-enhanced computed tomography (CT) or magnetic resonance angiography (MRA) after first-line ultrasonography. Standard surgical procedures were carried out in 22 patients. One patient with a nonruptured saccular aortic aneurysm and 2 patients with carotid aneurysms were managed only medically. For the patients with aneurysms located in the aortic bifurcation, we preferred aorto-bi-iliac bypasses; for the six extremity aneurysms, we were able to ligate the arteries; and for the other 10 extremity aneurysms we used polytetrafluoroethylene (PTFE) grafts for bypass procedures. All patients received immunosuppression with cyclophosphamide and corticosteroids before the operation and were continued in the postoperative period. All patients were examined between January and December 2010 paying special attention for new and anastomotic aneurysms and graft patency. Results There was one death and 1 patient was lost to follow-up. The remaining 23 patients (92%) were under follow-up after a mean of 7.4 ± 2.9 years after their operation. Four PTFE grafts (40%) inserted for extremity aneurysms occluded with no disabling consequences. Also, 6 patients who were treated with ligation postoperatively began to complain of mild to moderate claudication. In 2 patients, aneurysms recurred at the anastomotic site, whereas in 3 patients, new aneurysms developed at other sites. Conclusion The surgical management of large, nonpulmonary arterial disease of Behçet disease is currently quite satisfactory. When the false aneurysm is in the infrarenal aorta, aorto-bi-iliac bypass is the preferred surgical intervention. Extremity aneurysms can be treated with synthetic graft insertion. In selected cases, ligation can give satisfactory results; however, postoperative claudication is common. In some patients with small intact saccular aneurysms, surgery may not be necessary. Patients must be prescribed immunosuppressive therapy with cyclophosphamide and corticosteroids before and after the surgical intervention in order to avoid Behçet disease activation.