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Mozafar M, Najari D, Refaei M, Sheikhzadeh M, Mirhosseini MM. Innominate artery aneurysm in behcet disease; report of one case. Int J Surg Case Rep 2024; 116:109314. [PMID: 38325109 PMCID: PMC10859271 DOI: 10.1016/j.ijscr.2024.109314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Behçet disease (BD) is a multisystemic recurrent inflammatory disorder that was originally described as a triad of oral and genital ulcerations with uveitis (Behcet, 1937 [1]). Arterial involvement is the most common cause of mortality in patients with BD. Aneurysms are common among the arterial lesions and affect various arteries, but mostly the abdominal aorta. Vascular lesions are encountered in 7 %-29 % of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare (Bouarhroum et al. (2006) [2]). CASE PRESENTATION Herein, we present a 19 year old man presented with hoarsness due to pressure effect to our outpatient clinic. CLINICAL DISCUSSION Due to findings in the computed angiography, he underwent surgery twice.A 100*8 COVERA-covered stent was deployed at the bifurcation of the brachiocephalic artery. Then a 40*13.5 FLUENCY stent with a 2 cm overlap from the previous stent was deployed. CONCLUSION Further investigations regarding endovascular approach for this rare disease is recommended.
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Affiliation(s)
- Mohammad Mozafar
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Najari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Refaei
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sheikhzadeh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Moein Mirhosseini
- Division of Vascular and Endovascular Surgery, Department of Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tuzun H, Ak T, Bas A, Kara O, Gulsen F, Seyahi E. Abdominal aortic aneurysm healed with calcification in a female patient with Behçet's syndrome: A case report with a 2-decade follow-up. Int J Rheum Dis 2024; 27:e14859. [PMID: 37540105 DOI: 10.1111/1756-185x.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
Abdominal aortic aneurysms (AAA) are rare in Behçet syndrome (BS) but may result in life-threatening complications. AAA are generally treated with surgical intervention following aggressive immunosuppressive therapy. Healing with wall calcification and mural thrombus for AAA is scarcely reported in the literature. Herein, we present a female patient who developed a large saccular aneurysm in the infra-renal abdominal aorta 6 months after the diagnosis. Endovascular intervention was not found to be possible because of the dimensions of the aneurysm and the patient did not consent for open surgery. Therefore, she received only immunosuppressive treatment. By the second year of follow-up, we detected reduction in the size of AAA, along with circumferential wall calcification and mural thrombus. The patient was followed-up for 20 years without rupture and currently doing well. This case demonstrates that calcified large saccular AAA might not necessitate surgical intervention and be followed-up for many years without any complication.
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Affiliation(s)
- Hasan Tuzun
- Department of Cardiovascular Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tumay Ak
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ahmet Bas
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ozge Kara
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fatih Gulsen
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
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3
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Nagafuchi H, Kikuchi H, Ishibash H, Maeda H, Ogino H, Kirino Y, Sawada T, Saito K, Kuwana M, Hirohata S, Ishigatsubo Y, Niimi M, Okita Y, Miyata T, Shigematsu H, Takeno M. Recommendations for the management of the vascular involvement in Behçet's disease by the Japanese National Research Committee for Behçet's disease-secondary publication. Mod Rheumatol 2023; 34:182-193. [PMID: 36658731 DOI: 10.1093/mr/road002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to develop clinical guidelines for the management of vascular Behçet's disease (BD) by the Behçet's Disease Research Committee of the Ministry of Health, Labour and Welfare of the Japanese Government. METHODS A task force proposed clinical questions (CQs) concerning vascular BD based on a literature search. After screening, draft recommendations were developed for each CQ and brushed up in three blinded Delphi rounds, leading to the final recommendations. RESULTS This study provides recommendations for 17 CQs concerning diagnosis and differential diagnoses, assessment of disease activity, and treatment. The guidelines recommend immunosuppressive treatments, for both arterial and venous involvement with active inflammation. Anticoagulation is also recommended for deep vein thrombosis except in high-risk patients. Surgical and endovascular therapies can be optional, particularly in patients with urgent arterial lesions undergoing immunosuppression. In addition, two sets of algorithms for diagnosis and treatment are shown for arterial and venous involvement. CONCLUSIONS These recommendations are expected to serve as useful tools in the daily clinical practice of BD. This content has already been published in Japanese in the Guideline for the Management of Behçet's Disease 2020 and is submitted with permission from both the primary and secondary publishers.
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Affiliation(s)
- Hiroko Nagafuchi
- Division of Rheumatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirotoshi Kikuchi
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan
| | - Hiroyuki Ishibash
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hideaki Maeda
- Department of Cardiovascular Center, Ukima Central Hospital, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazuyoshi Saito
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Shunsei Hirohata
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | | | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Tetsuro Miyata
- Office of Medical Education, International University of Health and Welfare, Narita, Japan
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare, Narita, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Japan
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Samreen I, Darji P, Genobaga S, Doosetty S, Mohta T, Maity G, Vue C, Nakka S, Umeh C. Pulmonary Artery Aneurysm in Behcet Disease: Medical, Endovascular or Surgical Intervention. Cureus 2023; 15:e49368. [PMID: 38146562 PMCID: PMC10749288 DOI: 10.7759/cureus.49368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/27/2023] Open
Abstract
Behçet's disease is a chronic inflammatory condition that predominantly affects the body's blood vessels, exhibiting various clinical manifestations and complications. The exact cause remains unclear, but genetic predisposition, immune responses, and vascular activation are believed to contribute to its development. This disease is more prevalent in certain geographic regions and primarily affects young adults, particularly males. Pulmonary aneurysm, a complication of Behçet's disease, is the leading cause of mortality in Behcet disease. In this review, we summarize the complications of Behcet disease with a focus on pulmonary artery aneurysms. We discussed the medical, endovascular, and surgical management of pulmonary aneurysms in Behcet disease and the indications and outcomes of the different treatment options. Corticosteroids and cyclophosphamide remain the preferred first-line therapy. However, clinical improvement with infliximab or adalimumab, tumor necrosis factor-alpha (TNFα) blocking agents, have been reported after treatment failure with recommended first-line agents. In patients who fail medical therapy or those with life-threatening hemoptysis, endovascular or surgical intervention is the next option. Endovascular interventions include pulmonary artery embolization with coils or acrylic glue and using plugs, occluders, or stents. Endovascular interventions usually have fewer adverse effects than surgery. Although the risk of surgical procedures is high in pulmonary artery aneurysms, it could be a life-saving procedure in patients with life-threatening hemoptysis. Surgical options, including pulmonary artery ligation, aneurysmorrhaphy, segmentectomy, lobectomy, or pneumonectomy are available. However, the results of surgical therapy for Behçet aneurysms are often disappointing.
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Affiliation(s)
- Isha Samreen
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Puja Darji
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | | | | | - Tamanna Mohta
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Gargi Maity
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
| | - Chong Vue
- Internal Medicine, Hemet Global Medical Center, Hemet, USA
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Thouil A, Rhazari M, Alaoui H, Serraj K, Kouismi H. Bronchial Fissuring: A Severe Complication of Arterial Aneurysm. Cureus 2023; 15:e43029. [PMID: 37674955 PMCID: PMC10479719 DOI: 10.7759/cureus.43029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
Arterial aneurysms are rare and may occur in the context of Behçet's disease. The natural progression of these aneurysms can lead to an increase in their size and eventual rupture into the bronchi, causing life-threatening hemoptysis. We report a case of a subclavian artery aneurysm in a 30-year-old female patient with Behçet's disease who presented with moderate hemoptysis caused by a fistulized left subclavian artery aneurysm into the left main bronchus. The patient was treated with a bolus of corticosteroids followed by oral therapy, and six boluses of cyclophosphamide were scheduled. Unfortunately, the patient's condition deteriorated, and she died after her second cycle of cyclophosphamide following fulminant hemoptysis. The management of aneurysms in Behçet's disease is not standardized, but embolization appears to be the most promising conservative therapy.
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Affiliation(s)
- Afaf Thouil
- Laboratory of Research and Medical Sciences, Department of Respiratory Diseases, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Meriem Rhazari
- Department of Pulmonology, Mohammed VI University Hospital, Oujda, MAR
| | - Habiba Alaoui
- Laboratory of Immunohematology and Cellular Therapy, Department of Internal Medicine, Mohammed First University, Oujda, MAR
| | - Khalid Serraj
- Department of Internal Medicine, Mohammed First University, Oujda, MAR
| | - Hatim Kouismi
- Department of Pulmonology, Mohammed VI University Hospital, Oujda, MAR
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Naouli H, Jiber H, Bouarhroum A. Open repair of a recurrent abdominal aorta pseudoaneurysm in Behçet's disease. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:24-27. [PMID: 37120266 DOI: 10.1016/j.jdmv.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/28/2022] [Indexed: 05/01/2023]
Abstract
Vascular involvement is one of the major causes of mortality and morbidity in Behçet's disease (BD). Aneurysm or pseudoaneurysm formation is one of the vascular complications, and the aorta is the most common site. Currently, there is no definitive therapeutic modality. Both open surgery and endovascular repair are safe and effective options. However, the recurrence rate over the anastomotic sites is a major concern. We report a case of BD in a patient with recurrent abdominal aorta pseudoaneurysm 10 months after the first surgery. Preoperative corticosteroids followed by open repair were performed with good outcomes.
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Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, BP 1893, KM 2.200 Route Sidi Harazem, 30070 Fès, Morocco; Vascular surgery department, UHC Hassan II, Fez, Morocco.
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, BP 1893, KM 2.200 Route Sidi Harazem, 30070 Fès, Morocco; Vascular surgery department, UHC Hassan II, Fez, Morocco
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, BP 1893, KM 2.200 Route Sidi Harazem, 30070 Fès, Morocco; Vascular surgery department, UHC Hassan II, Fez, Morocco
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Mousa A, Abdelmohsen AA, Nasr MA, Zakaria MY, Sharabi SA, El Kasaby MI, Abd El Hamid AA, Abdul Hakim S, Nassar AK, El Azzazy M, Elkalla MA, Sharabi A. Adjunctive proximal aortic and aortodistal prosthetic wrapping of vascular anastomoses for Adamantiadis-Behçet's aortic/aortoiliac aneurysms: A revisit. Asian J Surg 2023; 46:483-491. [PMID: 35750611 DOI: 10.1016/j.asjsur.2022.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We described our local experiences with a single-layer wrapping technique for the vascular anastomoses in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms using InterGard Silver-impregnated Dacron® patch prosthesis. METHODS Between January 2013 to December 2019, we retrospectively reviewed 20 patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. All patients presented with Adamantiadis-Behçet's aortic/aortoiliac aneurysms. Two groups were analyzed, Group I, considered as a control group (n = 20). While group II (n = 20), of which prosthetic wrapping was performed. Follow up took place for a maximum of 24 months. RESULTS during a six-year retrospective study period, 20 patients were recruited. They included 15 males and five females (ratio 3:1). The median age was 30.5 ± 4.2 years. Anastomotic pseudoaneurysms were reported in group I (control, [non-wrapping group]). While group II doesn't (wrapping group). Paired samples t test revealed a significant difference between those underwent wrapping and those with non-wrapping (p = .019 and .038). False aneurysms were reported in 80% of the non-wrapping group as estimated by the Kaplan-Meier curves. While Log-rank test results revealed a significant difference between both the studied groups (p < .008). Primary graft patency was 90% at 24 months as reported by the Kaplan-Meier survival method. CONCLUSIONS adjunctive wrapping for vascular anastomoses using Intergard Silver-impregnated Dacron® patch in patients with Adamantiadis-Behçet's aortic/aortoiliac aneurysms is an applicable, simple, and reliable technique. It was associated with low morbidity and mortality rates. Moreover, we discussed a relatively old technique aiming to explore its success and safety in treating arterial aneurysms in Adamantiadis-Behçet's disease patients.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt.
| | - Abdelhalim A Abdelmohsen
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed A Nasr
- Department of Vascular Surgery and Endovascular Therapy, Assuit University Hospital, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt
| | - Mohamed Y Zakaria
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Sherif A Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed I El Kasaby
- Department of Ophthalmology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Aida A Abd El Hamid
- Department of Clinical Pathology, Al-Zahara'a University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Sami Abdul Hakim
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Abdelfattah K Nassar
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mohamed El Azzazy
- Department of Diagnostic and Interventional Radiology, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mai A Elkalla
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Alaa Sharabi
- Department of Vascular Surgery and Endovascular Therapy, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
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İscan HZ, Yigit G, Cetinkaya F, Erdogan K, Tumer NB, Ozen A, Mavioglu L, Unal EU. Early and Midterm Outcomes of Endovascular Treatment in Arterial Manifestations of Vascular Behcet Disease. Ann Vasc Surg 2022; 92:71-81. [PMID: 36587791 DOI: 10.1016/j.avsg.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet disease (VBD). This is a retrospective study evaluating 21 patients diagnosed with VBD who underwent endovascular treatment. METHODS This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and a requirement for reintervention. Secondary outcomes were complications and all causes of mortality. RESULTS Twenty-one patients underwent endovascular repair. In this study, 1 balloon-expandable stent for brachial artery aneurysm (4,8%), 1 viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (Thoracic endovascular aortic repair [TEVAR]) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), 1 chimney-TEVAR for saccular arcus thoracic aortic aneurysm (TAA) (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal abdominal aortic aneurysm (AAA) (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), and 6 EVAR for ruptured AAA (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50. 4 ± 10.7 months (8-66 months). The mean aneurysm diameter was 10,7 ± 53 mm. In the follow-up period, 3 patients presented with a hematoma at the insertion site of the sheath (14.3%). There were no early mortalities. Three patients required reintervention (14,3%); 1 of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1 ± 5,7% at 1 year, 85,6 ± 9,7% at 3 years, and 68,4 ± 17,1% at 5 years. CONCLUSIONS Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.
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Affiliation(s)
- Hakki Zafer İscan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Gorkem Yigit
- Department of Cardiovascular Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - Ferit Cetinkaya
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Kemal Erdogan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Naim Boran Tumer
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Anil Ozen
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Levent Mavioglu
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ertekin Utku Unal
- Department of Cardiovascular Surgery, Hitit University Medical Faculty, Çorum, Turkey
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Kim CH, So YH, Ok YJ, Choi JS. Bail-out coil embolization for a pseudoaneurysm of aortic sinotubular junction in a patient with Behcet's disease after receiving multiple aortic operations. J Card Surg 2022; 37:1410-1412. [PMID: 35148443 DOI: 10.1111/jocs.16304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
Transcatheter repair of a pseudoaneurysm of the aortic sinotubular junction with coils is quite challenging because it can cause coronary or systemic embolization of coils and aortic rupture. A 71-year-old female patient with Behcet's disease who had received repeated surgical aortic repairs presented with a complicated pseudoaneurysm. It developed not on the native aorta, but on the ascending aortic graft. It was positioned just beside the os of the attached trifurcated vascular graft trunk connecting arch vessels. To avoid reopening the sternum, which would have been fatal, coil embolization was successfully performed. This case suggests that transcatheter coil embolization might provide an alternative treatment option for such patients with a high risk of surgical mortality.
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Affiliation(s)
- Chan H Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young H So
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - You J Ok
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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10
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Lee S, Kang S, Eun Y, Kim H, Lee J, Koh EM, Kim DK, Cha HS. Clinical characteristics and radiographic outcomes of vascular Behçet’s disease involving the aorta or its major branches. Clin Rheumatol 2022; 41:1769-1777. [DOI: 10.1007/s10067-021-06031-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 02/02/2023]
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11
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Shaalan WE, El Emam AA, Lotfy HI, Naga AR. One-year results of stent graft repair for carotid artery pseudo-aneurysm in patients with Behcet's disease. Vascular 2021; 30:518-523. [PMID: 33977801 DOI: 10.1177/17085381211013641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Behcet's disease is a multisystem disorder of unknown etiology with vascular complications. This study reviewed the mid-term outcome of Behcet's disease patients with carotid artery pseudo-aneurysms treated by endovascular stent-graft repair at our unit. METHODS During a period of 11 years, six cases were included. Postoperative ultrasound duplex results were recorded along with computed tomography angiography report done a year after intervention. RESULTS The mean age (±SD) was 38 (±5.2) years. The mean (±SD) pseudo-aneurysm size was 33 (±12.2) mm. Technical success was 83%; failed cannulation of the internal carotid artery was encountered in one case. On day 2 post-operative, a duplex ultrasound revealed complete exclusion and thrombosis of the false aneurysm in all cases. A year later, a computed tomography angiography revealed a primary patency rate of 80%, and only one case had a recurrent pseudo-aneurysm at the distal margin of the stent graft. All cases, however, had complete thrombosis in the pseudo-aneurysms lumen with a mean (±SD) regression in size of 18 (±6) mm. The mean (±SD) percentage of in-stent stenosis was 34.5% (±11.73%). CONCLUSIONS Stent graft repair for carotid artery pseudo-aneurysm in Behcet's disease patients might be the preferable first line of treatment since it had a high technical success and mid-term primary patency rates, with additional fact that it obviously avoids the hazardous complications of surgery.
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Affiliation(s)
- Wael E Shaalan
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Ali A El Emam
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Hassan I Lotfy
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Ahmad R Naga
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
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12
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Bounssir A, Bakkali T, Mouhani S, Elkhaloufi S, Sefiani Y, El Mesnaoui A, Lekehal B. [Unusual complication of Behcet's disease]. Ann Cardiol Angeiol (Paris) 2021; 70:119-121. [PMID: 33032787 DOI: 10.1016/j.ancard.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Arterial involvement in Behcet's disease is rare and the tibioperoneal trunk localisation is exceptional. We report the case of a young men with Behcet's disease and in whom the evolution to angiobehcet was unusual. The medical treatment and the therapeutic abstention were decided according to a bundle of argument.
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Affiliation(s)
- A Bounssir
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - S Mouhani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - S Elkhaloufi
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - A El Mesnaoui
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
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Surgical Experience of Behcet's Disease Involving the Peripheral Artery. Ann Vasc Surg 2020; 69:246-253. [DOI: 10.1016/j.avsg.2020.05.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/27/2022]
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Kassaian SE, Molavi B, Abbasi K, Sadeghian M, Yazdani S. Endovascular Repair of a Common Carotid Pseudoaneurysm in a Patient with Behçet's Disease: A Case Report and Review of Literature. J Tehran Heart Cent 2020; 15:131-135. [PMID: 33552209 PMCID: PMC7827120 DOI: 10.18502/jthc.v15i3.4224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Behçet’s disease (BD) is a multisystem inflammatory disorder. Physicians should be alerted to the possibility of BD in a patient with a carotid artery pseudoaneurysm and no clear predisposing factor such as neck trauma or surgery. Endovascular repair of carotid pseudoaneurysms is technically feasible with excellent midterm follow-up results. Administration of immunosuppressive therapy before endovascular intervention is mandatory to reduce the chance of vascular complications accompanied by BD. A 40-year-old man presented with a painful and pulsatile neck mass with 2 episodes of transient ischemic attacks. The patient also complained of recurrent urogenital ulcers and aphthous lesions together with painful rashes. Ultrasonography and computed tomography angiography revealed 2 aneurysmal dilations in the left common carotid artery at the bifurcation level. He was referred to a rheumatologist, who made the diagnosis of BD. High-dose corticosteroids and cyclophosphamide were commenced. One week later, 2 overlapping self-expanding stent grafts were deployed. The final angiogram showed no residual endoleak, and the flow of the carotid and cerebral arteries was satisfactory. The patient was discharged with no neurological complications. Follow-up ultrasonography and computed tomography angiography 6 months later showed no endoleak, as well as significant shrinkage of the aneurysm sac.
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Affiliation(s)
| | - Behnam Molavi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kyomars Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrooz Yazdani
- Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran
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15
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Lin CH, Luo D, Ma HF, Shen Y, Zou J, Guan JL. Clinical characteristics and factors influencing the prognosis of Behçet’s disease complicated with vascular involvement. VASA 2020; 49:309-318. [PMID: 32228221 DOI: 10.1024/0301-1526/a000859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Summary: Background: Vascular Behçet's disease (VBD) might involve all sizes of arterial and venous vessels. Major vascular involvement caused the primary death in Behçet's syndrome (BS). We aimed to investigate the clinical characteristics and factors influencing the prognosis of VBD. Patients and methods: A retrospective analysis of the prospectively collected data of the Shanghai BS database from October 2012 to October 2018 was conducted. Patients who were diagnosed with BS and merged with venous thrombosis, arterial aneurysms, and arterial stenosis/occlusions were enrolled. Results: There were 47 patients with vascular involvement among 836 BS patients, 38 males and 9 females. The numbers of patients with venous thrombosis, arterial aneurysm, and arterial stenosis/occlusion were 25 (53.2 %), 21 (44.7 %), and 12 (25.5 %), respectively. Nearly half of the venous thromboses were located in limbs (n = 22, 46.8 %). Arterial aneurysm was the main form of arterial lesion. Most of the patients (93.6 %) were treated with corticosteroids and immunosuppressants. Late onset of BS or with arterial involvement had lower treatment response. Therapy with biological agents had significantly better results than that in the group without biological treatment (94.1 % vs. 80 %, P = 0.005). Conclusions: VBD showed a male preponderance and more than half of the patients presented with venous thrombosis. Late onset and arterial involvement were associated with poor prognosis. Therapy with biological agents is a viable alternative treatment to improve the prognosis.
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Affiliation(s)
- Chen-Hong Lin
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Hai-Fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
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16
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Isolated brachial artery aneurysm successfully treated with a covered stent in a patient with Behçet's disease. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:565-567. [PMID: 32082926 DOI: 10.5606/tgkdc.dergisi.2019.17852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
Abstract
Behçet's disease is a vasculitic pathology characterized by skin lesions, genital ulcers, aphthous stomatitis, and uveitis. Arterial aneurysms are rare in this disease. Herein, we report a rare case of an isolated brachial artery aneurysm with a history of Behçet's disease treated with endovascular covered stenting of the brachial artery.
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Hari G, Skeik N. Digital ischemia in Behçet's disease: case-based review. Rheumatol Int 2019; 40:137-143. [PMID: 31598753 DOI: 10.1007/s00296-019-04452-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022]
Abstract
Behçet's disease is a rare chronic autoimmune disease affecting primarily Middle and East Asian populations between the ages of 20 and 40 years. Behçet's disease manifests with oral and genital mucocutaneous lesions, ocular disease, venous thrombosis, and central nervous system degradation. Treatment can be challenging and may require immunosuppressive agents and/or topical wound-care. While larger vascular involvement has been reported, digital ischemia due to small-vessel involvement has not been well described in the literature. Based on a systematic literature review, we were only able to find seven published cases of limb ischemia, none of which reported digital involvement. We present a unique case of Behçet's disease with severe digital ischemia and ulceration caused by small-vessel involvement. The patient was managed successfully with antiplatelet, immunosuppressants, and anti-inflammatories with complete resolution of the ischemic symptoms. By focusing on small-vessel involvement and digital ischemia, we provide insight into clinical presentation and treatment for this very rare vascular manifestation of Behçet's disease.
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Affiliation(s)
- Gopika Hari
- Minneapolis Heart Institute®, Abbott Northwestern Hospital part of Allina Health, 33300, 920 E. 28th Street, Suite 300, Minneapolis, MN, 55407, USA
| | - Nedaa Skeik
- Minneapolis Heart Institute®, Abbott Northwestern Hospital part of Allina Health, 33300, 920 E. 28th Street, Suite 300, Minneapolis, MN, 55407, USA.
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18
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Mousa A, Sharabi A, Elkalla MA, Abdelhafez AA, Almulhim AS, Zakaria OM, Odeh AM. Prophylactic prosthetic wrapping for vascular anastomosis in patients with Behçet's aortic aneurysms: an experience from a resource-challenged setting. INT ANGIOL 2019; 38:484-493. [PMID: 31580038 DOI: 10.23736/s0392-9590.19.04038-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objectives of the current study were to evaluate our technical and clinical results of surgical treatment of infrarenal Behçet's abdominal aortic aneurysm (AAA). In addition to the prosthetic wrapping of the constructed anastomosis as a prophylactic measure for patients with vasculo-Behçet's disease, together with the administration of per- and postoperative immunosuppressive therapy. METHODS A single-center retrospective case series included 16 patients with vasculo-Behçet's AAA who treated with open surgical repair, between January 2005 and December 2013. The administration of immunosuppressive treatment was done preoperatively to achieve complete remission of the disease activity before starting the surgical repair. Patients' data were retrieved and analyzed emphasizing the diagnostic procedures, the used surgical techniques, and suitable graft selection, as well as, graft-related complications. The patients were followed up for one month to a maximum of 72 months. The median follow-up period was 24.83±9.4 months. RESULTS This study included 16 patients, 10 (63%) males, and 6 (37%) females, with the median age of (30.50 years, range: 21-37 years). Moreover, all patients were anticoagulated and discharged on warfarin and aspirin therapy. All surgical procedures were done on an elective basis except for only one emergency laparotomy, which was performed for a life-threatening ruptured aneurysm. The vascular anastomoses were performed using either interposition tube graft (for isolated AAA), or Y-shaped graft (for concomitant aorto-iliac aneurysms). Furthermore, prophylactic prosthetic wrapping was applied encircling the graft to the host artery. In addition, all patients received systemic immunosuppressive therapy post-surgical intervention to prevent anastomotic site complications. Technical success was obtained in 100% of cases. Moreover, the patients were followed up for a period of 12-72 months. Two anastomotic pseudoaneurysms were developed postoperatively. More interesting is that both were infected (one low-virulent that was conservatively treated and one overt that was surgically repaired). Furthermore, there was no aneurysm-related mortality. CONCLUSIONS Prophylactic prosthetic wrapping of vascular anastomosis in patients with Behçet's AAA in resource-challenged settings, where the proximal anastomoses were all end-to-end with wrapping, is an affordable, simple, reliable, and feasible technique, and commonly associated with a lower incidence of anastomotic site false aneurysms and different complications related to the implanted graft, where endovascular procedures might not be applicable. Moreover, the proper preoperative medical preparation for controlling the activity of Behçet's disease, with the administration of immunosuppressive agents, followed by immediate postoperative therapy, may have a good impact on the operative technical success and the prevention of the development of serious postoperative complications; especially anastomotic pseudoaneurysms (which may be complicated by fatal hemorrhage), as well as other graft-related complications.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery, Al Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt - .,Division of Vascular Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia -
| | - Alaa Sharabi
- Department of Vascular Surgery, Al Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Mai A Elkalla
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Abdelaziz A Abdelhafez
- Department of Vascular Surgery, Al Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, Egypt
| | - Abdulrahman S Almulhim
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ossama M Zakaria
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ahmed M Odeh
- Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Pardinas Gutierrez MA, Cabrera JL. Large pulmonary artery pseudoaneurysm in a patient with Behçet's disease treated with an Amplatzer vascular plug. BMJ Case Rep 2019; 12:12/6/e229516. [PMID: 31253661 DOI: 10.1136/bcr-2019-229516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the case of a 33-year-old man with Behçet's disease who presented with recurrent haemoptysis and a rapidly expanding right pulmonary artery pseudoaneurysm. Due to the significant risk of major bleeding and death, he was promptly treated with an Amplatzer vascular plug.
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Affiliation(s)
| | - Jorge Luis Cabrera
- Department of Pulmonary, Critical Care and Sleep Medicine, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
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20
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Yamamoto Y, Kudo T, Toyofuku T. Late-onset anastomotic pseudoaneurysm development 21-years after surgical treatment of arterial lesions in a patient with Behçet's disease. Scand J Rheumatol 2019; 48:415-417. [PMID: 31135247 DOI: 10.1080/03009742.2019.1599420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Y Yamamoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University , Tokyo , Japan
| | - T Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University , Tokyo , Japan
| | - T Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University , Tokyo , Japan
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21
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Multiple Overlapping Stent Implantation Combined with Coil Embolization for a Suprarenal Aortic Pseudoaneurysm with Impending Rupture in a Patient with Behçet's Disease. Ann Vasc Surg 2019; 60:476.e13-476.e17. [PMID: 31075471 DOI: 10.1016/j.avsg.2019.02.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 01/18/2019] [Accepted: 02/20/2019] [Indexed: 11/24/2022]
Abstract
Behçet's disease is an autoimmune vasculitis, which mainly manifests as aneurysm when arteries are involved. Treatments including graft interposition or stent-graft implantation are best performed after active inflammation subsides, otherwise there will be complications such as anastomotic pseudoaneurysms and graft occlusion. We report the treatment of a suprarenal abdominal aortic pseudoaneurysm in a patient with Behçet's disease via multiple overlapping stent implantation combined with coil embolization which was performed in a subacute fashion because of impending rupture of the pseudoaneurysm. She was maintained on long-term immunosuppressive therapy and remained symptom free at 2-year follow-up.
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22
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Mousa A, Hanbal I, Sharabi A, Nasr MA, Nassar AK, Elkalla MA. Vascular suture line wrapping for Aortoiliac anastomoses following open surgical repair of Infrarenal Behçet's Aortoiliac aneurysms. Orphanet J Rare Dis 2019; 14:81. [PMID: 30987653 PMCID: PMC6466776 DOI: 10.1186/s13023-019-1048-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/12/2019] [Indexed: 02/08/2023] Open
Abstract
Background This study was conducted to evaluate our local experiences of adjunctive mechanical prosthetic wrapping for aortoiliac vascular anastomoses as a prophylactic measure following surgical repair of Behçet’s aortoiliac aneurysms. The goal of prosthetic wrapping to reinforce the vascular anastomoses by mechanical protection to reduce the bleeding complications, and consequently pseudoaneurysm formation. This was aided by the administration of pre- and postoperative immunosuppressive therapy as an adjuvant treatment. Methods A seven-year retrospective study was conducted between January 2006 and December 2012, retrieving data of patients with Behçet’s aortoiliac aneurysms. All patients underwent open surgical repair using a heparin-bonded synthetic Dacron® graft. Data for all patients were retrieved and analyzed for diagnostic procedures, graft selection, as well as, different methods of surgical repair. Graft-related complications such as anastomotic pseudoaneurysms, occlusion, and thrombosis were also reported. Results Sixteen patients were recruited in this study. There were 11 (69%) males and 5 (31%) females with the male to female ratio 2:1. The patients’ age ranged between 25 and 47 years with the mean of 36.4 ± 7.3. All Behçet’s aortic/aortoiliac aneurysms were repaired by the application of heparin-bonded Dacron® tube and bifurcated grafts. The anastomotic wrapping technique was performed for both the proximal and the distal vascular anastomoses. The technical success of aortoiliac aneurysm and wrapping techniques was achieved in 100% of patients. All patients were given pre- and postoperative systemic immunosuppressive therapy. No graft-related complications were reported except for only one anastomotic pseudoaneurysm that developed at one of the right iliac anastomoses, that developed within 24 months after follow up. Conclusions Mechanical prosthetic wrapping for vascular anastomoses in patients with Behçet’s aortic/aortoiliac aneurysms is a feasible, simple, and reliable technique with low morbidity and mortality. It was performed as a prophylactic measure to avoid the development of postoperative anastomotic pseudoaneurysms. It must be performed for all patients with Behçet’s arterial aneurysms whenever possible. Furthermore, the supplemental administration of pre- and postoperative systemic immunosuppressive therapy should be considered as an important factor for the prophylaxis and prevention of anastomotic pseudoaneurysms and other graft-related complications.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular & Endovascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, 11675, Egypt. .,Division of Vascular & Endovascular Surgery, Department of Surgery, College of Medicine, King Faisal University, Eastern Province, Al-Ahsa, 31982, Saudi Arabia.
| | - Ibrahim Hanbal
- Department of Vascular & Endovascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, 11675, Egypt
| | - Alaa Sharabi
- Department of Vascular & Endovascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, 11675, Egypt
| | - Mohammed A Nasr
- Division of Vascular & Endovascular Surgery, Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Abdelfattah K Nassar
- Department of Rheumatology and Rehabilitation, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mai A Elkalla
- Medical Student, Faculty of Medicine, Helwan University, Cairo, Egypt
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Open surgical repair of abdominal aortic aneurysms in Behçet's disease. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:9-18. [PMID: 30770088 DOI: 10.1016/j.jdmv.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Behçet's disease (BD) is a multisystem chronic autoimmune inflammatory disorder that involves multiple organs. Arterial involvement in BD is rare. Aortic involvement is one of the most severe manifestations and is associated with a much higher mortality. In this article, we will present our experience in open surgical repair of abdominal aortic aneurysm combined with immunosuppressive therapy. METHODS Between January 2010 and December 2017, 7 patients were treated for abdominal aortic aneurysms (5 infra-renal and 2 supra-renal, in 1 woman and 6 men). All patients were Moroccan, the age range being 25-59 years, mean age 43.2 years. Three Dacron tube grafts, two Dacron aortobiiliac grafts and two patch closures were used. All 7 patients received immunosuppresive therapy after surgery. RESULTS All patients underwent successful open surgical repair without major complications during the 30 days immediately after the procedure. During a mean follow-up of 36 months, there was no recurrent aneurysmal localization, but one patient had lost their sight. Until now, we have been following 6 patients and they continue to receive immunosuppressive therapy. CONCLUSION Long-term immunosuppressive therapy after aneurysm repair is important to limit pseudoaneurysm recurrence. Through our serie, we describe the results of the combination of surgical treatment and adjunctive immunosuppressive therapy, with a literature review.
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Marie BD, Aminata D, Cherif MM, Daouda FM. Recurrent symptomatic ischemic stroke in a 46-year-old African male revealing Angio-Behçet with severe cardiovascular involvement. Egypt Heart J 2018; 69:75-80. [PMID: 29622958 PMCID: PMC5839345 DOI: 10.1016/j.ehj.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/04/2016] [Indexed: 11/24/2022] Open
Abstract
Behçet’sdisease (BD) is a chronic, multisystem vasculitis. It is categorized under variable vessel vasculitis in the new Chapel Hill nomenclature as it involves blood vessels of any type and size. It is characterized by relapsing aphthous ulcers commonly occurring in the oral mucosa and genitalia with ocular involvement. Other organ systems may be involved any time throughout the course of the disease. The exact cause is unknown. However, combination of genetic and environmental factors is likely to play a role. Cardiac involvement may occur in the form of intracardiac thrombus, endocarditis, myocarditis, pericarditis, endomyocardial fibrosis, coronary arteritis, myocardial infarction, and valvular disease. We present a case of Angio-Behçet in a 46-year-old African male with severe cardiovascular involvement including pulmonary artery hypertension (PAH), right ventricular failure and left ventricular diastolic dysfunction diagnosed after 2 episodes of symptomatic ischemic stroke resulting from complete occlusion of the right internal carotid artery (ICA) up to its intracranial portion. Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations. Nevertheless, prompt recognition of the primarily vascular manifestation of BD without mucocutaneous manifestations was responsible for considerable delay that did not afford surgical therapy for the carotid occlusion.
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Affiliation(s)
- Ba Djibril Marie
- Department of Cardiology and Internal Medicine, Military Hospital of Ouakam, Dakar, Senegal
| | - Diack Aminata
- Department of Cardiology and Internal Medicine, Military Hospital of Ouakam, Dakar, Senegal
| | | | - Fall Moussa Daouda
- Department of Cardiology and Internal Medicine, Military Hospital of Ouakam, Dakar, Senegal
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Ogino H. Surgical strategy for refractory aortitis. Gen Thorac Cardiovasc Surg 2018; 67:25-31. [PMID: 29404904 DOI: 10.1007/s11748-018-0885-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 01/16/2023]
Abstract
In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur. To prevent such sequelae in the early and late phases, continuous (life-long) as well as perioperative inflammation control using corticosteroid as an initial drug and/or other immunosuppression agents. This decade, instead of the conventional open surgical repairs, endovascular treatments have widely spread, predominantly for stenotic aortic/arterial lesions. In particular, for more difficult patients suffered from more troublesome Behçet disease, endovascular treatments would have greater advantages to avoid more occasionally occurred pseudo-aneurysm on the other parts as well as the surgical suture lines. The key issues on surgical treatment for refractory aortitis are perioperative inflammation control including the long term with corticosteroid and/or immunosuppressive agents, appropriate open surgical or endovascular treatment approaches, and sufficient reinforcement of surgical suture lines.
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Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
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Hasanaghaei T, Ghoddusi Johari H, Shenavandeh S. Huge femoral artery pseudoaneurysm in a patient with Behçet’s disease. THE EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ben Jmaà H, Karray R, Jmal H, Cherif T, Dhouib F, Souissi I, Karoui A, Bahloul Z, Masmoudi S, Elleuch N, Frikha I. [Surgical and endoluminal management of the inflammatory aortitis: A Tunisian center experience]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:213-220. [PMID: 28705339 DOI: 10.1016/j.jdmv.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/08/2017] [Indexed: 11/26/2022]
Abstract
Non-infectious aortitis is usually due to giant-cell arteritis, Takayasu disease or Behçet disease. The main aortic lesions are stenoses, occlusions and aneurysms in the Takayasu disease and aneurysms in the Behçet disease and giant-cell arteritis. Treatment is based on corticosteroid therapy and surgery. Endoluminal management is now the rule. We report a retrospective descriptive study of 10 patients who underwent surgical or endoluminal management of inflammatory lesions of the aorta between January 2000 and December 2015. There were 4 cases of Takayasu disease and 6 cases of Behçet disease. The aortic lesions were aneurysmal in all of the patients with Behçet disease. In the patients with Takayasu disease, aortic occlusions predominated, associated with other arterial lesions. Four patients with Behçet disease were managed surgically, and 2 patients underwent endovascular repair. All of the patients with Takayasu disease underwent surgery. Two patients died in the postoperative period, and two patients died during long-term follow-up. Systematic screening, as well as regular monitoring of the entire aorta during the follow-up, is necessary due to the frequency of aortic aneurysms.
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Affiliation(s)
- H Ben Jmaà
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie.
| | - R Karray
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - H Jmal
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - T Cherif
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - F Dhouib
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Souissi
- Service d'anesthésie-réanimation, hôpital Habib Bourguiba, Sfax, Tunisie
| | - A Karoui
- Service d'anesthésie-réanimation, hôpital Habib Bourguiba, Sfax, Tunisie
| | - Z Bahloul
- Service de médecine interne, hôpital Hédi Chaker, Sfax, Tunisie
| | - S Masmoudi
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - N Elleuch
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Frikha
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
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Yesin M, Toprak C, Acar E, Kalçık M, Taşçı AE, Pala S. The bronchial obstruction as a complication of endovascular repair of aortic pseudoaneurysm in Behçet's disease. Interv Med Appl Sci 2017; 8:127-130. [PMID: 28203395 DOI: 10.1556/1646.8.2016.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Behçet's disease (BD) is an autoimmune disorder affecting multiple organs. Aortic pseudoaneurysm is the most catastrophic lesion in BD. This lesion type is considered as a complicated and challenging pathology by surgeons because of the technical operative difficulties and frequent recurrence. So, the endovascular repair of inflammatory aortic pseudoaneurysm has been used as an alternative to open surgical repair. It is particularly important in patients who are high-risk surgical candidates because of comorbidities. In this report, we present a case and treatment of bronchial obstruction, which caused progressive dyspnea after endovascular repair of aortic rupture, in patient with known history of BD.
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Affiliation(s)
- Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital , Kars, Turkey
| | - Cüneyt Toprak
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital , Istanbul, Turkey
| | - Emrah Acar
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital , Istanbul, Turkey
| | - Macit Kalçık
- Department of Cardiology, İskilip Atıf Hoca State Hospital , Çorum, Turkey
| | - Ahmet Erdal Taşçı
- Department of Thoracic Surgery, Kosuyolu Kartal Heart Training and Research Hospital , Istanbul, Turkey
| | - Selçuk Pala
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital , Istanbul, Turkey
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Yin H, Li S, Wang M, Hu Z, Wang J, Yao C, Chang G, Wang S. The value of endografts in the surgical management of arterial lesions secondary to Behçet disease. J Vasc Surg 2017; 65:471-477. [DOI: 10.1016/j.jvs.2016.08.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/21/2016] [Indexed: 10/20/2022]
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Desbois AC, Wechsler B, Cacoub P, Saadoun D. Atteintes aortiques inflammatoires associées à la maladie de Behçet. Rev Med Interne 2016; 37:230-8. [DOI: 10.1016/j.revmed.2015.10.351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/27/2015] [Indexed: 11/27/2022]
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Gaudric J, Dennery M, Jouhannet C, Kagan N, Saadoun D, Chiche L, Koskas F. [Aortitis and surgery]. Rev Med Interne 2016; 37:284-91. [PMID: 26797187 DOI: 10.1016/j.revmed.2015.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/21/2015] [Indexed: 01/29/2023]
Abstract
Non-infectious aortitis are usually due to giant cell arteritis (temporal arteritis), Takayasu and Behçet's diseases. Aortitis should be suspected in the presence of aortic wall thickening or of aneurysm or occlusion of the aorta and its branches in the absence of characteristic cardiovascular risk factors. Surgery is required in case of severe damage. But the quiescence of the inflammatory disease must be obtained before endovascular or surgical treatment to prevent complications such as anastomotic false aneurysm or stent thrombosis, especially common in this disease. The frequency of aortic aneurysms (in particular of ascending aorta) in giant cell arteritis encourages its systematic screening, as well as regular monitoring of the entire aorta during the follow-up. Behçet's and Takayasu diseases require the greatest control of inflammation and the knowledge of some surgical tricks to avoid the risk of recurrence. The literature review shows that endovascular treatment could reduce perioperative morbidity but did not allow reducing long-term complications.
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Affiliation(s)
- J Gaudric
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - M Dennery
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Jouhannet
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - N Kagan
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Saadoun
- Service de médecine interne et immunologie clinique, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Chiche
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Koskas
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Liu Q, Ye W, Liu C, Li Y, Zeng R, Ni L. Outcomes of vascular intervention and use of perioperative medications for nonpulmonary aneurysms in Behçet disease. Surgery 2016; 159:1422-9. [PMID: 26765098 DOI: 10.1016/j.surg.2015.11.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Aneurysms attributable to Behçet disease (BD) are not common but are associated with a poor prognosis because of a high risk of rupture. Special considerations are required for vascular intervention, because the intense local inflammation may increase complications. The aim of this study was to assess the outcome of operative intervention and the use of perioperative medical therapy for aneurysms in patients with BD. MATERIALS AND METHODS We reviewed retrospectively the medical records of patients with BD admitted to Peking Union Medical College Hospital between January 1995 and January 2015. RESULTS Among 874 patients diagnosed with BD, 176 patients had vascular involvement, of whom 59 had arterial aneurysms. Thirty-six patients with 51 arterial aneurysms underwent operative intervention. The 51 primary operative interventions included 20 open operations and 31 endovascular interventions. Eleven (22 %) recurrent aneurysms developed in 10 patients and 5 (10%) thrombosis occurred in 5 patients. Of the 19 endovascular stents placed for aortic aneurysms, 1 type I endoleak, 1 graft occlusion, 3 recurrent aneurysms, and 1 recurrent aneurysmal rupture occurred. Among the revascularization procedures for extremity arteries, there were more complications with endovascular intervention than with open surgery. The cumulative risk of recurrent aneurysmal formation at the operative site was significantly less in patients treated with operative intervention combined with use of immunosuppressants than those treated with operative intervention alone (P = .01). CONCLUSION In patients with BD, an endovascular approach is feasible and effective for aortic aneurysms, whereas bypass surgery appears to provide better outcomes for extremity arterial aneurysms than placement of endovascular stents. The administration of corticosteroids combined with cyclophosphamide perioperatively decreases the cumulative risk of recurrent aneurysm.
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Affiliation(s)
- Qi Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yongjun Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Elsharawy MA, Elsaid A, Al-Dhafery B, Alghnimi I, Almabyouq F. Durability of aneurysm treatments in patients with active Behcet's disease. Vascular 2015; 24:454-60. [PMID: 26519256 DOI: 10.1177/1708538115611069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aneurysms in Behcet's disease are rare, serious, and recurrent. To achieve durable treatment, patients should receive immunosuppressive therapy before intervention to induce remission. We present early and long-term results of emergency cases of active Behcet's disease, which did not permit waiting for suppressive treatment. PATIENTS AND METHODS The study was undertaken on all cases admitted to the vascular unit, King Fahd Hospital of University for aneurysm treatment in patients with active Behcet's disease over about 10 years. All patients had exclusion of the aneurysm either by open surgery or endovascular intervention. Morbidities and mortality were recorded within the hospital admission and on the follow-up. RESULTS During the study period, three cases were included. All interventions were successful and lifesaving. However, two cases, treated with surgical interposition grafts, were blocked in the intermediate term follow-up (2-12 months) and one case, treated with endovascular treatment, complicated with pseudoaneurysm at femoral puncture site after six months. CONCLUSION Although early results were good, intermediate ones were not satisfactory because of progressive graft thrombosis and formation of new aneurysms. Awareness of these rare cases help for early identification and proper immunosuppressive before emergency vascular intervention is warranted.
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Affiliation(s)
- Mohamed A Elsharawy
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
| | - Aymen Elsaid
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
| | - Bander Al-Dhafery
- Department of Radiology, University of Dammam, Al-Khobar, Saudi Arabia
| | - Ibrahim Alghnimi
- Department of Radiology, University of Dammam, Al-Khobar, Saudi Arabia
| | - Fatimah Almabyouq
- Department of General Surgery (Vascular division), University of Dammam, Al-Khobar, Saudi Arabia
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Ohira S, Masuda S, Matsushita T. Nine-year Experience of Recurrent Anastomotic Pseudoaneurysms after Thoracoabdominal Aneurysm Graft Replacement in a Patient with Behçet Disease. Heart Lung Circ 2014; 23:e210-3. [DOI: 10.1016/j.hlc.2014.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/15/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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Ayari J, Mourali MS, Farhati A, Mechmeche R. Left main coronary artery thrombosis revealing angio-Behçet syndrome. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2014; 26:88-90. [PMID: 25541577 DOI: 10.4103/1110-7782.139578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although acute myocardial infarction commonly results from coronary atherothrombosis, there are several other etiologies that should be taken initially into account, especially in young adults without significant atherosclerotic risk factors. Thrombophilia and coronary arteritis are, in this context, examples of etiologies that should be looked after. Through this article, we present a case of Behçet's disease with arterial involvement diagnosed after myocardial infarction resulting from thrombosis of the left main coronary artery in a 38-year-old young man without any particular past medical history.
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Affiliation(s)
- Jihen Ayari
- Department of Cardiological Investigations and Resuscitation, La Rabta University Hospital, Tunis, Tunisia
| | - Mohamed S Mourali
- Department of Cardiological Investigations and Resuscitation, La Rabta University Hospital, Tunis, Tunisia
| | - Abdjalil Farhati
- Department of Cardiological Investigations and Resuscitation, La Rabta University Hospital, Tunis, Tunisia
| | - Rachid Mechmeche
- Department of Cardiological Investigations and Resuscitation, La Rabta University Hospital, Tunis, Tunisia
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Maladie de Behçet révélée par un anévrisme de l’artère splénique. Presse Med 2014; 43:729-31. [DOI: 10.1016/j.lpm.2013.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/05/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022] Open
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Faridhosseini R, Jabbari F, Shirkani A, Zandkarimi MR, Yousefzaedh H, Sahebari M, Basiri R. Multiple Right and Left Pulmonary Arteries and Subdivisions of Inferior Mesenteric Artery Aneurysms in Behcet's Disease Case: A Rare Clinical Presentation. Oman Med J 2014; 29:e072. [PMID: 30992738 DOI: 10.5001/omj.2014.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Behcet's disease is a multi-systemic inflammatory disorder with cutaneous acneiform eruptions, orogenital aphthae, uveitis, arthritis and systemic vascular inflammation. One of the rare vascular manifestations is thoraco-abdominal aortic and pulmonary aneurysm that is associated with high risk of morbidity and mortality. We report a 36-year-old man with chronic cough, hemoptysis, significant weight loss, and orogenital ulcers from one year before referral. Initial assessments revealed multiple parahillar nodules in chest X-ray, chronic inflammatory anemia, erythrocyte sedimentation rate more than 100, and positive Human Leukocyte Antigen B5 and B51. Evaluation for infection and malignancies was unremarkable. Open exploratory lung study showed multiple pulsatile nodules in both lungs. AMIGO computed tomogram confirmed multiple right and left pulmonary artery aneurysms and impending to rupture aneurysm at subdivision of inferior mesenteric artery. After beginning of three methylprednisolone and cyclophosphamide pulse doses, the clinical aspect of the patient dramatically improved. Although pulmonary aneurysm is a rare manifestation of Behcet's disease and it is more infrequent in the distal branches, it can be seen in patients presenting with inflammatory disease and respiratory manifestations and with Behcet's disease diagnosis. Corticosteroid pulse-therapy could be considered as the first line of medical treatment in these patients.
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Affiliation(s)
- Reza Faridhosseini
- Allergy Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farah Jabbari
- Allergy Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afshin Shirkani
- Allergy and Clinical Immunology Department, School of Medicine, Bushehr University of Medical Science, Bushehr, Iran
| | - Mohammad Reza Zandkarimi
- Allergist and Clinical Immunology Department, School of Medicine, Bushehr University of Medical Sciences, Mashhad, Iran
| | - Hadis Yousefzaedh
- PhD Student of Immunology, Immunology Research Center, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatologic Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Basiri
- Pulmonology Department, Qhaem Medical Center, Mashhad University of Medical Sciences, Mashhaad, Iran
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Ajili F, Tounsi H, Aouini F, Bousetta N, Ben Abdelhafidh N, Louzir B, Laabidi J, Othmani S. [A saccular aneurysm of the abdominal aorta revealing Behçet disease: when to operate?]. Pan Afr Med J 2014; 19:252. [PMID: 25852795 PMCID: PMC4382058 DOI: 10.11604/pamj.2014.19.252.5005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/27/2014] [Indexed: 11/11/2022] Open
Abstract
L'atteinte vasculaire est fréquente au cours de la maladie de Behçet. Elle est essentiellement représentée par les thromboses veineuses alors que l'atteinte artérielle est plus rare. Elle peut être isolée ou multifocale et peut toucher tous les territoires avec prédilection pour l'aorte abdominale, les artères pulmonaires et les artères des membres inférieurs. L'atteinte anévrysmale de l'aorte abdominale est trompeuse se manifestant par une symptomatologie atypique responsable d'un retard diagnostique favorisant la rupture. Dans notre cas, des douleurs abdominales paroxystiques ont incité le patient à consulter rapidement. L'enquête étiologique a conclue à un angio Behcet. Rarement, l'anévrysme de l'aorte abdominale est révélé par une complication telle que la rupture dans le rétro péritoine ou le tube digestif. Les indications chirurgicales des anévrysmes de l'aorte sont discutées ici. Un traitement immunosuppresseur au long cours s'impose en post opératoire pour limiter le risque de récidive.
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Affiliation(s)
- Faida Ajili
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | - Haifa Tounsi
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | - Fatma Aouini
- Service de Chirurgie Vasculaire et Unité de Greffe d'Organe, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | - Najeh Bousetta
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | | | - Bassem Louzir
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | - Janet Laabidi
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
| | - Salah Othmani
- Service de Médecine Interne, Hôpital Militaire de Tunis, 1008 Montfleury, Tunisie
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Kim SW, Lee DY, Kim MD, Won JY, Park SI, Yoon YN, Choi D, Ko YG. Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet's disease. J Vasc Surg 2013; 59:608-14. [PMID: 24246540 DOI: 10.1016/j.jvs.2013.09.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/11/2013] [Accepted: 09/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of endovascular stent grafting for surgical management of aortic pseudoaneurysm in patients with Behcet's disease (BD). METHODS We present a single-institution retrospective cohort of patients with aortic pseudoaneurysm and BD treated with aortic stent grafting. Computed tomography imaging was obtained preoperatively in all patients and once within 2 weeks postoperatively, and then annually. Clinical follow-up and erythrocyte sedimentation rate were used to follow BD activity. Immunosuppressant therapy was instituted prior to endovascular treatment unless a contraindication existed. RESULTS From 1998 to 2012, 10 patients (eight male, two female; median age, 39) with BD and aortic pseudoaneurysm were treated with endovascular stent grafting at this institution. Ninety percent of these patients received immunosuppressive therapy before and after surgical treatment. The median follow-up period was 57 months (interquartile range, 43-72). The locations of the 12 pseudoaneurysms treated in this cohort were infrarenal abdominal aorta (seven), descending thoracic aorta (four), and aortic arch (one). Median pseudoaneurysm size was 4.5 cm (interquartile range, 3.4-5.9). At long-term follow-up, complete resolution of the aortic pseudoaneurysm was noted in all patients. No endoleaks occurred. Newly developed pseudoaneurysm at the distal margin of the stent graft was noted in one patient 17 months after the stent graft procedure. One patient required a subsequent stent graft placement for an expanding pseudoaneurysm of the subclavian artery. No patient deaths occurred during the follow-up period. CONCLUSIONS Endovascular treatment of aortic pseudoaneurysm with stent-grafting in patients with BD is safe and effective with long-term durability.
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Affiliation(s)
- Sung Won Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Yun Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Man Deuk Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jong Yun Won
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Il Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Nam Yoon
- Department of Cardiothoracic Surgery, Cardiovascular Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Departments of Internal Medicine, Cardiovascular Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Departments of Internal Medicine, Cardiovascular Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Peripheral arterial involvement in Behcet’s disease: an analysis of the results from a Korean referral center. Rheumatol Int 2013; 33:2101-8. [DOI: 10.1007/s00296-013-2700-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
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41
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Adler S, Baumgartner I, Villiger PM. Behçet's disease: successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis. Arthritis Care Res (Hoboken) 2012; 64:607-11. [PMID: 22162223 DOI: 10.1002/acr.21557] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effect of infliximab in patients with inflammatory vascular lesions due to Behçet's disease (BD). METHODS Seven patients with clinical evidence of severe vascular BD were analyzed: 3 patients with aortic involvement, 1 with recurrent venous thrombosis of the pelvic veins, 1 with recurrent venous and arterial thromboses of the thigh, and 2 with retinal vasculitis. Infliximab was initiated with 3-5 mg/kg of body weight and infusions were repeated in intervals of 4 weeks as either first-line therapy in 3 patients or add on after failure of conventional immunosuppression in the remaining 4. Ongoing immunosuppression consists of a various combination of azathioprine (n = 2), methotrexate (n = 3), cyclosporine (n = 3), and low-dose glucocorticoids (n = 3). RESULTS Control of inflammation was seen 1-5 days after infliximab induction in all patients. C-reactive protein level was reduced from a mean of 89 mg/liter prior to infliximab to 9 mg/liter thereafter. Vision increased rapidly in patients with retinal vasculitis. Vascular grafts remained patent. The inflamed and dissected aortic wall healed over a period of 6 months. Infliximab could be stopped in 2 patients; intervals could be extended in 4 to a maximum of 8 weeks. Infliximab and basic immunosuppression were well tolerated; no drug-induced side effects were recorded. CONCLUSION Infliximab is effective in inducing and maintaining remission of vasculitic activity in patients with BD. The rapid effect together with excellent tolerability suggests that infliximab should be considered as a first-line agent in severe vascular BD.
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Affiliation(s)
- Sabine Adler
- University Hospital and University of Bern, Bern, Switzerland
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42
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Mekouar F, Elomri N, Elqatni M, Taberkant M, Ghafir D, Sekkach Y. Une tuméfaction douloureuse de la cuisse. Rev Med Interne 2012; 33:162-4. [DOI: 10.1016/j.revmed.2011.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/19/2011] [Indexed: 11/25/2022]
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Tuzun H, Seyahi E, Arslan C, Hamuryudan V, Besirli K, Yazici H. Management and prognosis of nonpulmonary large arterial disease in patients with Behçet disease. J Vasc Surg 2012; 55:157-63. [DOI: 10.1016/j.jvs.2011.07.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
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45
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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46
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Abstract
A doença de Behçet é uma doença inflamatória que pode envolver o tórax manifestando-se pela presença de aneurismas das artérias pulmonares. Relatamos um caso de doença de Behçet cujas alterações observadas em radiografias e tomografia computadorizada do tórax sugeriram a possibilidade do diagnóstico.
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Koksoy C, Gyedu A, Alacayir I, Bengisun U, Uncu H, Anadol E. Surgical treatment of peripheral aneurysms in patients with Behcet's disease. Eur J Vasc Endovasc Surg 2011; 42:525-30. [PMID: 21641238 DOI: 10.1016/j.ejvs.2011.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 05/09/2011] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Our aim was to report our experience with 23 patients presenting with 32 peripheral aneurysms secondary to Behcet's disease (BD) and their outcome after vascular surgery. METHODS The study was retrospective in nature. Except for those presenting with aneurysm rupture, patients underwent surgery after treatment of acute inflammatory lesions. All aneurysms appeared to be pseudo-aneurysms. Graft interposition with polytetrafluoroethylene or saphenous vein was most commonly employed. Postoperatively, all patients were put on immunosuppressive and antiplatelet therapy. Follow-up was done every 6-12 months, complications recorded and managed appropriately. RESULTS All the patients were males. The mean age at diagnosis of a peripheral aneurysm was 41.0 ± 9 years. There were 17 (53%) femoral, 8 (25%) popliteal, two carotid, two external iliac, two brachial and one internal iliac aneurysms. Fourteen (61%) patients had a single peripheral aneurysm while nine had two. Surgery was performed for all initially presenting 23 aneurysms. Six patients with multiple peripheral aneurysms had surgery for their second asymptomatic aneurysm. The mean follow-up period was 84 ± 62 months. Of 29 aneurysms operated on, 7 (24%) anastomotic pseudo-aneurysms and 11 (38%) graft occlusions developed. Five (22%) patients underwent major lower extremity amputations. Six (26%) mortalities were recorded. CONCLUSION Surgery for peripheral aneurysms in BD is warranted in many instances. Results of operation can be improved by prolonged monitoring. However, despite all efforts, peripheral aneurysm involvement in BD worsens the prognosis.
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Affiliation(s)
- C Koksoy
- Division of Vascular Surgery, Dept of General Surgery, Ankara University Medical Faculty, Ankara, Turkey.
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Rico JV, Pedrajas FG, González IC, Segura Iglesias RJ. Urgent Endovascular Treatment of a Ruptured Tibioperoneal Pseudoaneurysm in Behçet’s Disease. Ann Vasc Surg 2011; 25:385.e11-4. [PMID: 21276706 DOI: 10.1016/j.avsg.2010.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 08/31/2010] [Accepted: 10/05/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Jorge Vilariño Rico
- Department of Vascular Surgery, University Hospital of A Coruña, Xubias de Arriba s/n, A Coruña, Spain.
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Abstract
PURPOSE OF REVIEW Large vessel vasculitis occurs in a subgroup of patients with Behçet's disease who are at high risk for disease-related morbidity and mortality. Recognition of patients at risk, early detection of vasculitis, and aggressive treatment are essential for optimal care of these patients. We review the expanding knowledge on large vessel problems in Behçet's disease, highlighting recent contributions. RECENT FINDINGS Vasculo-Behçet patients are at risk for multiple vessel-related complications including thromboses, stenoses, occlusions, and aneurysms. The primary reason for clot seems to be an inflammatory process in the vessel wall. Less invasive endovascular procedures are increasingly used to treat aneurysms in Behçet patients. SUMMARY Because of earlier recognition, aggressive medical treatment, and novel surgical procedures, the morbidity and mortality of large vessel vasculitis in Behçet's disease are improving.
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Kim SD, Won YS, Yun SS, Park SC, Kim JI, Moon IS, Koh YB. Aortic transection and diverting bypass as treatment of repetitive recurrent abdominal aortic false aneurysm rupture in a patient with Behcet's disease. Ann Vasc Surg 2010; 25:267.e1-5. [PMID: 20932713 DOI: 10.1016/j.avsg.2010.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 04/08/2010] [Accepted: 07/19/2010] [Indexed: 11/17/2022]
Abstract
Abdominal aortic false aneurysms in patients with Behcet's disease have been reported frequently and repaired successfully by various procedures; however, anastomotic false aneurysms have often been reported to occur after the operation. In this article, we report a case of four-time repetitive, recurrent suprarenal abdominal aortic false aneurysm ruptures that lasted for 7 years. The location of this aneurysm was not easy to repair not only by open surgical procedures but by endovascular stent because the aortic defect was too close to the visceral arterial branches. The last operation consisted of primary repair of aortic defect, transection of abdominal aorta at the level of supraceliac aorta with end closure, and a thoracic aorta to abdominal aorta bypass with Dacron graft. An 8-year follow-up revealed no more abdominal aortic aneurysm recurrence.
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Affiliation(s)
- Sang-Dong Kim
- Department of Surgery, The Catholic University Medical Center, Seoul, Korea
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