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Pathadan AP, Tyagi S, Gupta MD, M P G, Mahajan S, Kunal S, Mahajan B, Bansal A. The study of novel inflammatory markers in takayasu arteritis and its correlation with disease activity. Indian Heart J 2021; 73:640-643. [PMID: 34627584 PMCID: PMC8514415 DOI: 10.1016/j.ihj.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 07/24/2021] [Accepted: 08/04/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives Currently, erythrocyte sedimentation rate (ESR) and highly sensitive serum C-reactive protein (hsCRP) levels are used to monitor disease activity and guide therapy in Takayasu Arteritis (TA). However, non-specificity of these markers suggests the need for novel biomarkers. In this pilot study, we explore the role of novel biomarkers for evaluating disease activity in TA. Methods A total of 40 patients with TA were divided into active and stable disease groups. Disease activity was assessed according to the National Institutes of Health criteria proposed by Kerr et al. Routine blood investigations were obtained and serum tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-18, ESR, hsCRP levels and NLR (neutrophil to lymphocyte ratio) were assayed at baseline and after 6 months. Results Among the 40 patients enrolled, 18 were classified as active while 22 were stable at baseline and with a similar pattern at 6 months. Along with ESR and hsCRP, IL-6 and IL-18 levels were significantly higher in the active disease group than in the stable disease group (p < 0.005). The levels of other novel biomarkers (IL-1, TNF-α) and NLR were not significantly higher in active disease group. Conclusion Serum IL-6 and IL-18 levels correlates well with disease activity in TA which suggests their important role in disease pathogenesis and may be helpful in guiding and monitoring therapy in active TA patients.
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Affiliation(s)
- Antony P Pathadan
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Sanjay Tyagi
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Mohit D Gupta
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
| | - Girish M P
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Sudhanshu Mahajan
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | | | - Bhawna Mahajan
- Division of Biochemistry, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
| | - Ankit Bansal
- Division of Cardiology, GB Pant Institute of Post Graduate Medical Education and Research, Delhi, India
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Águeda AF, Monti S, Luqmani RA, Buttgereit F, Cid M, Dasgupta B, Dejaco C, Mahr A, Ponte C, Salvarani C, Schmidt W, Hellmich B. Management of Takayasu arteritis: a systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis. RMD Open 2019; 5:e001020. [PMID: 31673416 PMCID: PMC6803017 DOI: 10.1136/rmdopen-2019-001020] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/02/2019] [Accepted: 08/20/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To collect available evidence on management of large vessel vasculitis to inform the 2018 update of the EULAR management recommendations. Methods Two independent systematic literature reviews were performed, one on diagnosis and monitoring and the other on drugs and surgical treatments. Using a predefined PICO (population, intervention, comparator and outcome) strategy, Medline, Embase and Cochrane databases were accessed. Eligible papers were reviewed and results condensed into a summary of findings table. This paper reports the main results for Takayasu arteritis (TAK). Results A total of 287 articles were selected. Relevant heterogeneity precluded meta-analysis. Males appear to have more complications than females. The presence of major complications, older age, a progressive disease course and a weaker inflammatory response are associated with a more unfavourable prognosis. Evidence for details on the best disease monitoring scheme was not found. High-quality evidence to guide the treatment of TAK was not found. Glucocorticoids are widely accepted as first-line treatment. Conventional immunosuppressive drugs and tumour necrosis factor inhibitors were beneficial in case series and uncontrolled studies. Tocilizumab failed the primary endpoint (time to relapse) in a randomised controlled clinical trial; however, results still favoured tocilizumab over placebo. Vascular procedures may be required, and outcome is better when performed during inactive disease. Conclusions Evidence to guide monitoring and treatment of patients with TAK is predominantly derived from observational studies with low level of evidence. Therefore, higher-quality studies are needed in the future.
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Affiliation(s)
- Ana F Águeda
- Rheumatology, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Sara Monti
- Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
- University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Frank Buttgereit
- Rheumatology and Clinical Immunology, Charité University Medicine Berlin (CCM), Berlin, Germany
| | - Maria Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital, Westcliff-on-Sea, UK
| | - Christian Dejaco
- Rheumatology, Department of Rheumatology, South Tyrol Health Trust, Hospital of Bruneck, Bruneck, Italy
- Rheumatology, Medical University Graz, Graz, Austria
| | - Alfred Mahr
- Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | - Cristina Ponte
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Rheumatology, Centro Hospitalar de Lisboa Norte, EPE, Hospital de Santa Maria, Lisboa, Portugal
| | - Carlo Salvarani
- Rheumatology, Università di Modena e Reggio Emilia and Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Wolfgang Schmidt
- Medical Centre for Rheumatology, Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie Berlin-Buch, Immanuel Krankenhaus, Berlin, Germany
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitis-Zentrum Süd, Medius Kliniken, – Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-unter-Teck, Germany
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Mhaske SM, Patil B, Patwardhan SK, Gopalakrishnan G, Shelke UR, Pamecha YG. Outcome following renal autotransplantation in renal artery stenosis. Urol Ann 2019; 11:46-52. [PMID: 30787570 PMCID: PMC6362799 DOI: 10.4103/ua.ua_39_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction With significant advances in the area of interventional radiology, angioplasty and stenting have become preferred first-line treatment in patients with significant renal artery stenosis. However, not all patients have favorable anatomy to undergo minimally invasive treatments, and reconstruction of the renal artery is an option. In select cases, either improved renal function or maintenance of existing function and sometimes resolution of hypertension can follow surgical treatment. Material and Methods This was a prospective observational study conducted from August 2010 to June 2016. Patients <45 years of age with uncontrolled hypertension secondary to renovascular hypertension (RVH) and refractory to medical management and renal arterial disease unfavorable for percutaneous intervention were included in the study. All patients were evaluated thoroughly using computed tomography angiography and diethylenetriaminepentaacetic acid renal scan. Patients underwent autotransplantation either into the right or left iliac fossa. Some kidneys required bench reconstruction of the renal artery and/or its branches before being implanted into either iliac fossa. Results Nine patients were included in the study. The mean age was 27 years. Seven were males and two were females. Five patients had bilateral renal artery stenosis. After autotransplantation, initially five patients became free of antihypertensive medicines, but on the follow-up, two patients showed rising trend of blood pressure. The evaluation revealed narrowing at anastomosis site in both patients with salvageable kidney function in one patient. Angioplasty with stenting was done in this patient while the second patient underwent secondary nephrectomy. At 2 years of follow-up, four patients required no antihypertensive medicines. Conclusion Autotransplantation can be a successful treatment of severe RVH and should be considered in patients with renal arterial disease unfavorable for percutaneous intervention.
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Affiliation(s)
- Sunil M Mhaske
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Bhushan Patil
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sujata K Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Umesh Ravikant Shelke
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Yash G Pamecha
- Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Peng M, Ji W, Jiang X, Dong H, Zou Y, Song L, Zhang H, Zhang W, Yang Y, Gao R. Selective stent placement versus balloon angioplasty for renovascular hypertension caused by Takayasu arteritis: Two-year results. Int J Cardiol 2016; 205:117-123. [DOI: 10.1016/j.ijcard.2015.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
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Ozpak B, Ilhan G. Biosynthetic Versus Polytetrafluoroethylene Graft in Extra-anatomical Bypass Surgery of Takayasu Arteritis Patients With Supra-aortic Disease. J Cardiovasc Thorac Res 2015; 7:101-6. [PMID: 26430497 PMCID: PMC4586595 DOI: 10.15171/jcvtr.2015.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION To evaluate treatment outcomes of patients diagnosed with Takayasu arteritis (TA), who underwent extra-anatomical bypass surgery using biosynthetic grafts. METHODS This retrospective study included 12 TA patients considered eligible for surgical revascularization between January 2005 and May 2011 from two vascular surgical units in Turkey. Control group consisted of 12 peripheral arterial disease patients who underwent supra-aortic extra-anatomical bypass surgery using polytetrafluoroethylene (PTFE) graft. Preoperatively, all patients underwent Doppler ultrasound and arteriography. Patients were examined every 3 months for clinical findings after monthly follow-up during the first 6 months, first, second and third year controls. Graft patencies were evaluated by Doppler ultrasound at each visit. RESULTS The mean age was 38.6 ± 4.2 years and the mean follow-up time was 37.9 ± 6.9 months for the study group. In Biosynthetic Group, subclavian-subclavian (n = 2), axillo-axillary (n =9) and carotico-subclavian (n = 1) bypass operations were performed. In PTFE group, subclavian-subclavian (n = 3), axillo-axillary (n = 7), subclavian-left ulnar (n = 1), subclavian-distal brachial (n = 1) bypass operations were performed. Graft occlusion occurred in four patients in PTFE Group during follow-up period. These occlusive lesions were treated successfully according to the routine of each vascular unit. CONCLUSION We concluded that in inflammatory diseases like TA, biosynthetic grafts have promising patency, postoperative clinical findings and lower rates of complications requiring reintervention in mid-term.
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Affiliation(s)
- Berkan Ozpak
- Department of Cardiovascular Surgery, Tekirdag State Hospital, Tekirdag, Turkey
| | - Gokhan Ilhan
- Department of Cardiovascular Surgery, Faculty of Medicine, Recep Tayyip Erdogan University, Tekirdag, Turkey
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Keser G, Direskeneli H, Aksu K. Management of Takayasu arteritis: a systematic review. Rheumatology (Oxford) 2013; 53:793-801. [DOI: 10.1093/rheumatology/ket320] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, Mignot C, Schoindre Y, Chiche L, Hatron PY, Emmerich J, Cacoub P. Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis. Circulation 2012; 125:813-9. [PMID: 22230484 DOI: 10.1161/circulationaha.111.058032] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.
Methods and Results—
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25–50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2–11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication–free survival rates were 78% (IQR, 69%–88%), 67% (IQR, 57%–78%), 56% (IQR, 46%–70%), and 45% (IQR, 34%–60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42–39.39;
P
=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (
P
<0.001) and C-reactive protein (
P
<0.001) and fibrinogen (
P
<0.005) serum levels compared with those without complications.
Conclusions—
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.
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Affiliation(s)
- David Saadoun
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Marc Lambert
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Tristan Mirault
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Mathieu Resche-Rigon
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Fabien Koskas
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Philippe Cluzel
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Cécile Mignot
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Yoland Schoindre
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Laurent Chiche
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Pierre-Yves Hatron
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Joseph Emmerich
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
| | - Patrice Cacoub
- From the Service de Médecine Interne 2 (D.S., Y.S., P.C.) and Laboratory I3 Immunology, Immunopathology, Immunotherapy (D.S., P.C.), UMR CNRS 7211, INSERM U959, Hôpital Pitié-Salpétrière, Paris; Service de Médecine Interne, Centre hospitalier régional universitaire de Lille, Lille (M.L., P.-Y.H.); Service de Médecine Vasculaire, Hôpital européen Georges–Pompidou (AP-HP), and Université Paris Descartes, INSERM U765, Paris (T.M., J.E.); Departement de Biostatistiques, INSERM U717, Hôpital Saint-Louis,
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Ham SW, Kumar SR, Rowe VL, Weaver FA. Disease progression after initial surgical intervention for Takayasu arteritis. J Vasc Surg 2011; 54:1345-51. [DOI: 10.1016/j.jvs.2011.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022]
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Aortorenal Bypass with Autologous Saphenous Vein in Takayasu Arteritis-induced Renal Artery Stenosis. Eur J Vasc Endovasc Surg 2011; 42:47-53. [DOI: 10.1016/j.ejvs.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/09/2011] [Indexed: 11/23/2022]
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Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, Ishibashi-Ueda H, Kobayashi J, Yagihara T, Kitamura S. Overview of Late Outcome of Medical and Surgical Treatment for Takayasu Arteritis. Circulation 2008; 118:2738-47. [PMID: 19106398 DOI: 10.1161/circulationaha.107.759589] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hitoshi Ogino
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Kenji Minatoya
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hiroaki Sasaki
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hiroshi Tanaka
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Yu Matsumura
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Hatsue Ishibashi-Ueda
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Toshikatsu Yagihara
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
| | - Soichiro Kitamura
- From the Departments of Cardiovascular Surgery (H.O., H.M., K.M., H.S., H.T., Y.M., J.K., T.Y., S.K.) and Pathology (H.I.), National Cardiovascular Center, Osaka, Japan
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Paraskevas N, Castier Y, Fukui S, Alsac JM, Soury P, Laurian C, Leseche G. Superficial femoral artery autograft reconstruction for complicated popliteal artery entrapment syndrome. Vasc Endovascular Surg 2008; 43:165-9. [PMID: 19033275 DOI: 10.1177/1538574408326584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present an alternative surgical approach to popliteal artery entrapment syndrome with vascular complications in the absence of a suitable saphenous vein. Three patients (29, 35, and 78 years old) with thrombotic and/or aneurysmal lesions of the popliteal artery from popliteal artery entrapment syndrome were treated with superficial femoral artery autograft reconstruction. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction and the harvested segment was replaced by a polytetrafluoroethylene graft. At follow-up, patients were asymptomatic and duplex ultrasound revealed patent reconstruction with no morphological abnormalities.
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Affiliation(s)
- Nikolaos Paraskevas
- Service de Chirurgie Vasculaire, Hôpital Saint-Joseph, Paris, France, Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, Paris Cedex 18, France.
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Paraskevas N, Castier Y, Fukui S, Soury P, Thabut G, Leseche G, Laurian C. Superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysm: Long-term outcome. J Vasc Surg 2008; 48:311-6. [PMID: 18571367 DOI: 10.1016/j.jvs.2008.03.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/26/2008] [Accepted: 03/29/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This prospective, observational study evaluated the safety and efficacy of superficial femoral artery autograft reconstruction in the treatment of popliteal artery aneurysms in the absence of a suitable saphenous vein. METHODS From March 1997 to April 2007, data from patients with popliteal artery aneurysms treated by superficial femoral artery reconstruction were prospectively collected in two centers. The procedure was performed through a medial approach. The superficial femoral artery was harvested in the upper third of the thigh and used as the conduit for reconstruction, and the harvested segment was replaced by a polytetrafluoroethylene graft. The patients were observed for survival, limb salvage, and reconstruction patency. The results were calculated by the Kaplan-Meier method. RESULTS During the 10-year study period, 37 popliteal artery aneurysms in 32 patients (all men; median age, 71 years) were treated by reconstruction using the superficial femoral artery. Indications for surgical treatment were symptomatic or complicated aneurysms in 11 (30%). Four (11%) of the 37 popliteal artery aneurysms were thrombosed, and 33 (89%) were patent. At surgery, 35% had a single vessel runoff. Because of acute ischemia, reconstruction was performed as an emergency procedure in three patients (8%). There were no perioperative deaths, early amputations, or early thrombosis. The mean follow-up period was 36 months (range, 7-103 months). Two grafts thrombosed during follow-up. At 3 years, the primary and secondary patency rates were 86% and 96%, and overall limb salvage was 100%. Follow-up duplex ultrasonography did not detect any aneurysmal dilatation of the autograft. CONCLUSION Our experience shows that superficial femoral arterial reconstruction is a safe and useful treatment option in patients with popliteal artery aneurysms who lack suitable saphenous veins. This reconstruction seems to be a good alternative to prosthetic bypass crossing the knee joint, and our results suggest that this study should be continued.
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Melby SJ, Thompson RW. Diseases of the Great Vessels and the Thoracic Outlet. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davidovic L, Sindjelic R, Jovanovic Z, Bozic V, Markovic D. Takayasu's aortoarteritis. ACTA CHIRURGICA IUGOSLAVICA 2006; 52:95-8. [PMID: 16813003 DOI: 10.2298/aci0503095d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu's aortoarteritis, are presented here. Both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurologic symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediatelly after the operation and during the first three postoperative months. By this reason an infection af the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu's aortoarteritis is very unsommon in our country, as well as in other countries which don't belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu's aortoarteritis is a complex disease. It requires combined dignostic and therapeutic approaches which produce satisffied long-term results.
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Affiliation(s)
- L Davidovic
- Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti, Beograd
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16
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Fields CE, Bower TC, Cooper LT, Hoskin T, Noel AA, Panneton JM, Sullivan TM, Gloviczki P, Cherry KJ. Takayasu’s arteritis: Operative results and influence of disease activity. J Vasc Surg 2006; 43:64-71. [PMID: 16414389 DOI: 10.1016/j.jvs.2005.10.010] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 10/03/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the short- and long-term outcomes of patients treated operatively for Takayasu's arteritis and the effect of disease activity on results. METHODS Forty-two (17%) of the 251 patients enrolled in our Takayasu's arteritis registry between 1975 and 2002 required operation for symptomatic disease. Data were obtained from the registry, patient records, phone correspondence, and written surveys. RESULTS There were 38 females and 4 males with a median age of 29 years (range, 12 to 56 years), and 32 (76%) were white. Sixty operations were performed for symptomatic disease. The mean duration of symptoms before operation was 5.6 months (range, 0 to 25 months). Thirteen (31%) patients had active disease and underwent operation for acute presentation or failure of medical management. Thirty-nine patients (93%) had operation for occlusive disease. Twenty-two (52%) patients had involvement of both the great and abdominal aortic branch vessels; 10 (24%) had great vessel disease alone; 9 (21%) had involvement of abdominal arteries; and 1 (2%) had coronary artery disease. There was no operative death, myocardial infarction, major stroke, or renal failure. Three patients had early graft thrombosis, two had a minor stroke, and two developed hyperperfusion syndrome. The median follow-up was 6.7 years (range, 1 month to 19.3 years). Eleven (26%) patients required 15 graft revisions; five of the patients had active disease at the time of initial operation. All early revisions (<1 year) were in patients with active disease. By Kaplan-Meier analysis, freedom from revision at 5 and 10 years was 100% in patients with quiescent disease not requiring steroids (group I, n = 5, 12%), 95% and 81% in patients whose disease was quiescent on steroids (group II, n = 24, 57%), 57% in patients with active disease on steroids (group III, n = 7, 17%), and 33% in patients with active disease and no long-term steroids (group IV, n = 6, 14%) (P < .006). The rate of revision or progression of disease at another site in 5 years was 0% in group 1, 10% in group 2, 57% in group 3, and 67% in group 4 (P < .001) The differences were even more pronounced when an analysis was done on the basis of disease activity alone, irrespective of steroid use. During the follow-up period, 3 of 39 great vessel, 2 of 18 mesenteric/renal, and 1 of 9 aortofemoropopliteal reconstructions occluded. The predicted mortality for patients was 4% at both 5 and 10 years (95% CI) respectively (confidence interval [CI], 0% to 11%) and 10 (CI, 0% to 14%) years, respectively. CONCLUSIONS The minority of patients with Takayasu's arteritis require operation. In our predominantly white female patient population, occlusive symptoms were the most common indication for operation. Operation for these selected patients was safe, with no operative mortality, myocardial infarction, major stroke, or renal failure. Patients with active disease requiring operation are more likely to require revision or develop progressive symptomatic disease at another site. Long-term survival is excellent, regardless of disease activity at the time of operation.
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Affiliation(s)
- Charles E Fields
- Division of Vascular Surgery, Mayo Clinic and Foundation, Rochester, Minn., USA
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Galaria II, Suroweic SM, Davies MG. Combined endovascular and open approach in renal salvage for acute renal artery in-stent thrombosis: the danger of undiagnosed Takayasu's disease. Eur J Vasc Endovasc Surg 2004; 28:674-6. [PMID: 15531206 DOI: 10.1016/j.ejvs.2004.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2004] [Indexed: 11/21/2022]
Affiliation(s)
- I I Galaria
- Division of Vascular Surgery, Center for Vascular Disease, University of Rochester Medical Center, Rochester, NY 14642, USA
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Kieffer E, Chiche L, Bertal A, Koskas F, Bahnini A, Blã Try O, Cacoub P, Piette JC, Thomas D. Descending Thoracic and Thoracoabdominal Aortic Aneurysm in Patients with Takayasu's Disease. Ann Vasc Surg 2004; 18:505-13. [PMID: 15534728 DOI: 10.1007/s10016-004-0073-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
From June 1974 to December 2001 we performed operative treatment on 33 patients with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease. There were 25 men and 8 women with a mean age of 40.2A years (range 16-64A years). Nineteen patients came from North Africa, 6 were from France, and 8 were from various locations in the world. The revealing symptom was hypertension in 12 cases, thoracic or abdominal pain in 7, isolated inflammatory syndrome in 5, neurologic or ocular manifestations in 3, rupture in 3, and embolization to the lower extremity in 1. In the remaining two cases discovery was coincidental. The aneurysm was confined to the thoracic aorta in 10 cases and involved both the thoracic and abdominal aorta in 23 cases. There were 8 type I, 6 type II, 4 type III, and 5 type IV aneurysms according to Crawford's classification. Two patients had undergone previous repair of the thoracoabdominal aorta. Four patients required first-stage treatment of a renal artery lesion to control hypertension. Six patients had associated aneurysms of the proximal aorta, including five treated via the distal elephant trunk technique in first-stage procedures. Aneurysm repair consisted of prosthetic replacement of the thoracoabdominal aorta in 31 cases, exclusion bypass in 1 case, and stent graft placement in 1 case. The procedure was performed with cross-clamping alone in 13 cases, distal perfusion in 17 cases, and deep hypothermic circulatory arrest in 3 cases. Twenty patients (61%) had associated renal and/or intestinal artery lesions that were treated during the same procedure as that for the thoracoabdominal aorta in 19 patients (58%). A total of 24 procedures were performed on renal arteries (17 revascularizations, 7 nephrectomies). Associated supraaortic trunks lesions were present in 15 patients (45%) and were treated in 12 patients, including 8 in first-stage procedures prior to thoracoabdominal aortic aneurysm repair. Three patients died of multiple organ failure, after reoperation in two cases and infection in one case involving prior long-term corticosteroid therapy. Three patients developed paraplegia, including one who had undergone emergency treatment following rupture. Two patients required reoperation, for hematoma in one case and bowel necrosis in one. Four patients developed respiratory complications requiring artificial ventilation for more than 48 hr. During follow-up, two patients died from complications after repair of the proximal aorta and one patient required nephrectomy. Despite the extent of aneurysmal lesions and high frequency of association with visceral and supraaortic vessel lesions, the outcome of surgery in patients presenting with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease was satisfactory.
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Affiliation(s)
- Edouard Kieffer
- Department of Vascular Surgery, Internal Medicine, and Cardiology, Pitié-Salpêtrière University Hospital Center, Assitance Publique-Hopitaux de Paris (AP-HP), Paris, France.
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Weaver FA, Kumar SR, Yellin AE, Anderson S, Hood DB, Rowe VL, Kitridou RC, Kohl RD, Alexander J. Renal revascularization in Takayasu arteritis–induced renal artery stenosis. J Vasc Surg 2004; 39:749-57. [PMID: 15071436 DOI: 10.1016/j.jvs.2003.12.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was undertaken to define the long-term effects of renal revascularization on blood pressure, and renal and cardiac function in patients with Takayasu arteritis-induced renal artery stenosis (TARAS). METHODS Twenty-seven patients (25 women; mean age, 27 years) with TARAS underwent intervention. Primary, primary assisted, and secondary patency rates were determined, and the late effects on blood pressure, renal and cardiac function, and survival were analyzed. RESULTS All patients had hypertension (mean blood pressure, 167/99 mm Hg; 2.5 antihypertensive medications per patient). Mean estimated glomerular filtration rate in patients not receiving hemodialysis was 76 mL/min, and in five patients serum creatinine concentration was greater than 1.5 mg/dL. Three patients were hemodialysis-dependent, and two had intractable congestive heart failure. Forty interventions were performed, including 32 aortorenal bypass procedures, two repeat implantations, four nephrectomies, and two transluminal angioplasty procedures. Postoperative morbidity was 19%. There were no deaths. During follow-up (mean, 68 months), three graft stenoses, all due to intimal hyperplasia, and three graft occlusions occurred. Two of three graft stenoses were successfully revised. At 1, 3, and 5 years of follow-up, primary patency was 87%, 79%, and 79%, respectively; primary assisted patency was 93%, 89%, 89%, respectively; and secondary patency was 93%, 89%, and 89%, respectively. Intervention resulted in a decrease in blood pressure to a mean of 132/79 mm Hg (P<.0001), and the need for antihypertensive medications was reduced to one per patient (P<.01). Mean glomerular filtration rate increased to 88 mL/min (P<.005), and two patients no longer required hemodialysis. Congestive heart failure resolved in both patients, and did not recur. There were three deaths during follow-up, with 5-year and 10-year actuarial survival of 96% and 80%, respectively. CONCLUSIONS Renal revascularization to treat TARAS is durable, has a salutary effect on blood pressure, and enhances long-term renal and cardiac function. This response establishes renal revascularization as a successful and durable intervention for TARAS, and a benchmark to which other therapies should be compared.
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Affiliation(s)
- Fred A Weaver
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033-4612, USA.
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Kumar A, Dubey D, Bansal P, Sanjeevan KV, Gulati S, Jain S, Sharma RK. Surgical and radiological management of renovascular hypertension in a developing country. J Urol 2003; 170:727-30. [PMID: 12913683 DOI: 10.1097/01.ju.0000081997.69890.f3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined the long-term outcome of radiological and surgical intervention in young patients with renovascular hypertension. MATERIALS AND METHODS Between 1989 and 2001, 85 patients with a mean age +/- SD of 21 +/- 10.3 years, including 59 with Takayasu's arteritis (TA) and 26 with fibromuscular dysplasia (FMD), underwent radiological (percutaneous transluminal angioplasty) or surgical treatment for renovascular hypertension due to renal artery stenosis. The technical success, complications and clinical response of each treatment were compared. RESULTS Of the patients 29 with TA and 20 with FMD underwent a total of 56 balloon angioplasties. Technical success was achieved in 94.58 renal units with a clinical response in 41 patients (83.9%). However, the re-stenosis rate was 24.13% in TA and 10% in FMD cases. A total of 41 surgical procedures were performed in the 28 and 7 patients with TA and FMD, respectively, including aortorenal bypass with vein in 12, and with a polytetrafluoroethylene graft in 4, lienorenal bypass in 4, iliorenal bypass in 2, gastroduodenal bypass in 1, autotransplantation in 1, nephrectomy in 14 and partial nephrectomy in 2. The clinical response rate to renal revascularization procedures was 94.4%, whereas it was only 50.0% for nephrectomy/partial nephrectomy during a median followup of 42 months (range 9 to 96). CONCLUSIONS Percutaneous transluminal angioplasty and renal revascularization provide comparable long-term results in the management of renal artery stenosis due to TA and FMD. Although it is technically complex, surgery for TA is safe and effective. However, the rate of re-stenosis following angioplasty for TA is higher compared with FMD.
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Affiliation(s)
- Anant Kumar
- Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, India.
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el Asri A, Tazi-Mezalek Z, Aouni M, Adnaoui M, Mohattane A, Bensaid Y, Maaouni A. [Takayasu's disease in Morocco. Report of 47 cases]. Rev Med Interne 2002; 23:9-20. [PMID: 11859700 DOI: 10.1016/s0248-8663(01)00510-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. We studied Moroccan patients to evaluate clinical, biological, radiological and evolution features of this disease in our country. METHODS Forty-seven patients with Takayasu's arteritis were studied retrospectively between 1988 et 1999. RESULTS In our series involvement of the aortic arch and its branches was more frequent than the abdominal aorta and its branches. Stenotic lesions of renal arteries were rare. Ultrasound was useful in the diagnosis and the monitoring of the disease. Treatment with glucocorticoids gave good results, with improvement in half of the patients and remission with stabilisation in 40% of cases. Tuberculosis occurred in 8.5% of patients. CONCLUSION The use of ultrasound and computed tomography angiography is helpful for the diagnosis and monitoring of the disease progression. Glucocorticoids help to induce long remission in about 80% of treated patients. We don't find any relationship between Takayasu's arteritis and tuberculosis.
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Affiliation(s)
- A el Asri
- Service de médecine interne, hôpital Ibn-Sina, 10000 Rabat, Maroc
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Diseases of the Thoracic Aorta and Great Vessels. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Iwai T, Inoue Y, Matsukura I, Sugano N, Numano F. Surgical technique for management of Takayasu's arteritis. Int J Cardiol 2000; 75 Suppl 1:S135-40. [PMID: 10980352 DOI: 10.1016/s0167-5273(00)00186-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anastomotic aneurysm may occur after surgical treatment of Takayasu's arteritis. We describe a surgical technique designed to prevent this problem. The technique includes a bypass from a donor artery to a nondiseased distal artery, reinforcement of the suture line to prevent stretching or expansion at the anastomoses, and minimization of inflow perfusion to the brain. The technique was used in two patients, whose grafts were patent 1 and 2 years, respectively, after surgery. Careful differential diagnosis is essential to the success of this method, which may also be used to treat aortic aneurysm resulting from Behcet's disease but which is not appropriate for mid-aortic syndrome or Buerger's disease.
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Affiliation(s)
- T Iwai
- First Department of Surgery, School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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Noris M, Daina E, Gamba S, Bonazzola S, Remuzzi G. Interleukin-6 and RANTES in Takayasu arteritis: a guide for therapeutic decisions? Circulation 1999; 100:55-60. [PMID: 10393681 DOI: 10.1161/01.cir.100.1.55] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with Takayasu arteritis, circulating lymphocytes are activated, and histological findings indicate that cell-mediated immunity plays an important role in the pathogenetic sequence leading to vascular lesions. METHODS AND RESULTS To delineate the profile of inflammatory and chemoattractant cytokines involved in T-cell activation in Takayasu arteritis, we measured by ELISA serum levels of interleukin (IL)-6, IL-1beta, and RANTES in 18 patients. Subsequently, we wanted to establish whether any of these molecules could be used as a marker to monitor the clinical course of the disease and to predict disease exacerbations. We found that all patients with Takayasu arteritis studied during an active phase of the disease have increased serum concentration of IL-6 compared with healthy control subjects (P<0.01). Enhanced IL-6 serum levels paralleled disease activity to the extent that its serum concentrations were comparable to those of control subjects when patients were studied in remission. RANTES concentrations were also higher than normal in the serum of all patients with Takayasu arteritis (P<0.01) studied during an active phase of the disease. RANTES serum levels tended to normalize in remission, but values remained higher than those of control subjects (P<0.05). In contrast, serum concentrations of IL-1beta were below the detection limit of ELISA in both healthy subjects and all patients with Takayasu arteritis. A positive correlation was found between either IL-6 (rho=0.705, P<0.01) or RANTES (rho=0.607, P<0.05) serum level and disease activity. CONCLUSIONS The close correlation of serum IL-6 and RANTES levels with disease activity suggests that these cytokines contribute to vasculitic lesions in Takayasu arteritis and raises the possibility that their monitoring in serum helps clinicians find adequate treatment adjustments in individual patients.
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Affiliation(s)
- M Noris
- Clinical Research Center for Rare Diseases "Aldo e Cele Daccò," Mario Negri Institute of Pharmacological Research, Bergamo, Italy
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Lambert M, Hachulla E, Hatron PY, Perez-Cousin M, Beregi JP, Warembourg H, Devulder B. [Takayasu's arteritis: vascular investigations and therapeutic management. Experience with 16 patients]. Rev Med Interne 1998; 19:878-84. [PMID: 9887455 DOI: 10.1016/s0248-8663(99)80060-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There is no consensus in regard to vascular explorations and therapeutical management of Takayasu's arteritis. The objective of this study was therefore to establish the most appropriate vascular explorations and to analyze current treatments. METHODS Clinical, biological and morphological findings related to either diagnosis or treatment were retrospectively evaluated in sixteen patients diagnosed with Takayasu's arteritis according to the American College of Rheumatology criteria. RESULTS Median delay between the occurrence of the first symptoms and the diagnosis was 9 months. Aortic lesions and aortic valvular incompetence were more frequent. Statistical analysis showed the existence of a correlation between the lack of relapse and corticosteroid therapy (Fisher exact test, P = 0.021). Percutaneous transluminal angioplasty led to stabilization of vascular lesions. Surgical management led to satisfactory results, except for patients with aortic lesions, as survival was then less than 1 year. CONCLUSION Early diagnosis is mandatory in patients with Takayasu's arteritis in order to propose appropriate therapy, particularly corticosteroid therapy. Surgery and angioplasty prove to be useful in occlusive forms. Late diagnosis is accompanied by severe aortic lesions and fatal outcome.
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Affiliation(s)
- M Lambert
- Service de médecine interne A, hôpital Claude-Huriez, CHRU de Lille, France
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Abstract
Investigators form the National Institutes of Health (NIH), in the United States, have prospectively studied 60 patients with Takayasus's arteritis over a period of 20 years. Unique observations resulted from the requirement that all patients be part of Institutional Review Board-approved standardized protocols that required periodic complete clinical, laboratory and angiographic evaluations, regardless of degree of disease activity. Patients judged to have active disease received protocol defined treatment that always included prednisone, and to which cytotoxic agents were added in the event that relapse followed tapering or withdrawal of corticosteroids. The prospective standard approach applied to this cohort has provided new insights into the presentation, course and treatment-responsiveness of Takayasu's arteritis. This article will focus on the questions raised by this study and implications for patient care.
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Affiliation(s)
- G S Hoffman
- Department of Rhewnatic and Immunologic Diseases/A50, Cleveland Clinic Foundation, OH 44195, USA
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Robbs JV, Abdool-Carrim AT, Kadwa AM. Arterial reconstruction for non-specific arteritis (Takayasu's disease): medium to long term results. EUROPEAN JOURNAL OF VASCULAR SURGERY 1994; 8:401-7. [PMID: 7916304 DOI: 10.1016/s0950-821x(05)80957-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is little information on reconstructive arterial surgery for Takayasu Arteritis, and the approach is generally negative in this regard. Common causes of death are stroke, aneurysm rupture and the complications of renovascular hypertension and renal failure. The present study aims to examine the results of arterial reconstruction in the medium and long term in patients with histologically proven Takayasu's disease. In the last 11 years 134 patients have been referred to the vascular service of whom 81 (60%) were suitable for operation. Forty-nine were women; age range 3-45 years (average 29.5 years). In 28 the disease was confined to the aortic arch (Type 1); 41 had descending aortic involvement (Type II); six had a combination of arch and aortic disease (Type 111) and two associated cardiac lesions (Type IV). Four had isolated peripheral lesions (Type V). Seventy percent of these lesions were aneurysmal. Of the 28 type I patients, two had aortic arch reconstruction, seven segmental replacement. Of the 49 with type II, III and IV disease 26 had thoraco-abdominal aortic replacement using a bypass technique. The remainder had infrarenal aortic replacement and bypass procedures. Type V (four patients) had interposition grafts. Overall operative mortality in the Type I patients was 3.6% (stroke) and in the type II-IV 4%. All of the latter followed operation for aneurysm rupture and there were no elective deaths. Three months to 11 years after operation four patients (5%) developed fatal progression of the disease and seven (8.9) non-fatal disease progression of whom three required surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J V Robbs
- Metropolitan Vascular Service, Division of Surgery, University of Natal, Durban, Republic of South Africa
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