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Kang M, Zhang B, Pang H, Hu H, Zhang J. Case Report: Coil embolization of ascending aortic pseudoaneurysm in patient with Behcet's disease. Front Cardiovasc Med 2024; 11:1392236. [PMID: 38903968 PMCID: PMC11187288 DOI: 10.3389/fcvm.2024.1392236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/24/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behcet's disease (BD) is a systematic vasculitis that affects vessels with various sizes, presenting as venous thrombosis and arterial pseudoaneurysms. The most severe manifestation in BD is ascending aortic pseudoaneurysm, which is associated with high risks of rupture and mortality. Case presentation We present a case of ascending aortic pseudoaneurysm in a 50-year-old patient with BD. After preoperative evaluation, coil embolization was successfully performed to treat the pseudoaneurysm, resulting in a satisfactory outcome at the 1-year follow-up. Conclusion Coil embolization serves as an effective treatment option for ascending aortic pseudoaneurysm in BD when open surgical repair and stent graft placement are unsuitable.
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Affiliation(s)
| | | | | | | | - Junbo Zhang
- Department of Peripheral Vascular Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Lian W, Song X, Cui L, Zheng Y, Liu C, Ni L. Endovascular repair with a physician-modified fenestrated endograft to treat abdominal aortic pseudoaneurysm with Behcet's disease: a case report. J Cardiothorac Surg 2024; 19:56. [PMID: 38311787 PMCID: PMC10840177 DOI: 10.1186/s13019-024-02523-2] [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: 05/29/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Aortic involvement in patients with Behcet's disease (BD) is rare, but it is one of the most severe manifestations. Open surgical repair of aortic aneurysm is challenging considering the high risk of postoperative recurrent anastomotic pseudoaneurysms and is associated with a much higher mortality rate. Recently, endovascular treatment has proven to be a feasible, less invasive alternative to surgery for these patients. CASE PRESENTATION We report a total endovascular repair of a paravisceral abdominal aortic pseudoaneurysm in a 25-year-old male patient with BD. The pseudoaneurysm was successfully excluded, and the blood supply of visceral arteries was preserved with a physician-modified three-fenestration endograft under 3D image fusion guidance. Immunosuppressive therapy was continued for 1 year postoperatively. At 18 months, the patient was asymptomatic without abdominal pain. Computed tomography angiography demonstrated the absence of pseudoaneurysm recurrence, good patency of visceral vessels. DISCUSSION AND CONCLUSIONS Endovascular repair using physician-modified fenestrated endografts is a relatively safe and effective approach for treating paravisceral aortic pseudoaneurysm in BD patients. This technique enables the preservation of the visceral arteries and prevents aneurysm recurrence at the proximal and distal landing zones, which are common complications of open surgical repair in these patients. Furthermore, we emphasize the importance of adequate immunosuppressive therapy before and after surgical repair in BD patients, which is a major risk factor for recurrence and poor prognosis.
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Affiliation(s)
- Wenzhuo Lian
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xitao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Liqiang Cui
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Leng Ni
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Li S, Kan H, Liu Z, Zeng R, Shao J, Chen Y, Ye W, Zheng Y. Aortic calcification correlates with pseudoaneurysm or penetrating aortic ulcer of different etiologies. Sci Rep 2024; 14:25. [PMID: 38167947 PMCID: PMC10761832 DOI: 10.1038/s41598-023-49429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Chronic risk factors for pseudoaneurysm (PSA) or penetrating aortic ulcer (PAU) have not been fully clarified. This study aims to evaluate the association of aortic calcification with PSA or PAU of different etiologies. Totally 77 pseudoaneurysms, 80 PAU, and 160 healthy controls (HCs) were retrospectively included, of which 30 were infected, 34 were immunological, and 93 were atherosclerotic etiologies. The aortic calcification status, position of aortic tears/ulcers, and risk factors for disease or acute aortic syndrome (AAS) were identified. Atherosclerotic patients aged more than 65 and infective patients aged more than 60 had significantly higher calcification scores. The immunological group had a lower level of calcification in the infrarenal aorta. For patients of infective or atherosclerotic etiology, 60% (18/30) and 60.22% (56/93) of the tears/ulcers occurred at the aortic parts with the highest level of calcification. Patients with longitudinal calcification exceeding 1/3 of the aortic arch had an increased risk of acquiring diseases (OR = 13.231). The presence of longitudinal calcification of the descending aorta or cross-sectional calcification of the infrarenal aorta increased the risks of acquiring diseases (OR = 8.484 and 8.804). After adjusting for age, longitudinal calcification of the descending aorta exceeding 1/3 length was found to be associated with AAS (OR = 4.662). Tears/ulcers of pseudoaneurysm and PAU were both generally found at the part of the aorta with most calcification. Distinct aorta calcification characteristics were observed for lesions of different etiologies. Longitudinal thoracic and cross-sectional infrarenal abdominal aortic calcification increased the risk of acquiring diseases, and descending aortic calcification was associated with symptomatic patients.
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Affiliation(s)
- Siting Li
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoxuan Kan
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhili Liu
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Zeng
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Ye
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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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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Chen GX, Wan JH, Chen CW, Huang B. Hybrid surgery management challenges of a Behcet's disease patient with recurrence of aortic aneurysms: a case report. Front Cardiovasc Med 2023; 10:1097129. [PMID: 37719979 PMCID: PMC10502721 DOI: 10.3389/fcvm.2023.1097129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behcet's disease is a vasculitis of unknown origin that can involve multiple organs or tissues. Aneurysm or pseudoaneurysm, also one of the complications of Behcet's disease, is usually accompanied by a poor prognosis. Surgery is usually accompanied by a high risk of complications, such as the recurrence of anastomotic pseudoaneurysms and blockage of the target vessel. Using hybrid surgery, we successfully treated a complex and recurrent abdominal aortic pseudoaneurysm in a patient with BD. Methods We report a 32-year-old female diagnosed with Behcet's disease with recurrent thoracoabdominal aortic aneurysm. Adequate immunotherapy was given during the perioperative period. The splanchnic artery branches were reconstructed, and the aneurysm was sequestered with endovascular repair. The patient recovered uneventfully and was discharged from the hospital 8 days after hybrid surgery. At the 60-month follow-up, no aneurysm was observed, the stent had no displacement or internal leakage, and the reconstructed blood vessels were unobstructed. Conclusion Hybrid surgery could be a feasible and effective strategy for BD aneurysms. Adequate preoperative and postoperative immunotherapy with arterial anastomosis away from the diseased artery may be the key to success.
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Affiliation(s)
- Guo Xin Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Hong Wan
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Chu Wen Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wu L, Li F, Sun X, Liu Z, Zhou J, Zheng W, Chen Y, Zheng Y. Long Term Outcomes and Potential Risk Factors for Endovascular Repair of Aortic Pseudoaneurysms in Vascular Behçet's Disease. Eur J Vasc Endovasc Surg 2023; 66:169-177. [PMID: 37068704 DOI: 10.1016/j.ejvs.2023.04.009] [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: 07/26/2022] [Revised: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This study aimed to analyse long term outcomes and risk factors for endovascular repair of aortic pseudoaneurysms in patients with vascular Behçet's disease (BD). METHODS Medical records of 26 aortic vascular BD patients who underwent endovascular treatment at the vascular department of Peking Union Medical College Hospital between January 2002 and December 2021 were reviewed retrospectively. Erythrocyte sedimentation rate (ESR) and C reactive protein were used to assess BD activity. Computed tomography angiography (CTA) was obtained pre- and post-operatively for almost all patients. Univariable logistic regression analysis was used to analyse risk factors for endovascular repair, such as inflammatory indicators, drug usage, and stent graft parameters. RESULTS The abdominal aorta (n = 17) was the most common site of 27 vascular BD pseudoaneurysms in this study. CTA also revealed one aortic arch pseudoaneurysm, seven descending thoracic aortic pseudoaneurysms, one thoraco-abdominal aortic pseudoaneurysm, and one pseudoaneurysm at the aortic bifurcation. Most of the pseudoaneurysms were treated with covered stent grafts. The technical success rate was 96% and no deaths occurred during hospital stay. The mean follow up was 5.8 ± 5.5 years and 31% (8/26) experienced post-operative complications. Overall one, three, and five year event free survival rates were 87%, 78%, and 74%, respectively. Univariable logistic regression analysis revealed that pre-operative ESR ≥ 16.0 mm/h (p = .040), pre-operative glucocorticoid (GC) use ≤ 11.5 days (p = .024), pre-operative immunosuppressant use ≤ 15.5 days (p = .028), and length of proximal landing zone ≤ 1.95 cm (p = .034) were associated with a worse prognoses following endovascular treatment. Proximal oversize ≥ 9.5% (p = .074) was also regarded as a risk factor, although not statistically significant. CONCLUSION This study further confirmed the feasibility of endovascular repair for aortic vascular BD patients. Risk factors predicting poor prognoses included elevated pre-operative ESR, insufficient pre-operative GC use or immunosuppressant use, inadequate proximal landing zone, and larger proximal oversize percentage.
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Affiliation(s)
- Lianglin Wu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangda Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoning Sun
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingya Zhou
- Department of Medical Record, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Zheng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Centre for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Zou L, Liu H, Jiang X, Chen B, Jiang J, Shi Y, Ma T, Lin C, Fu W, Dong Z. Long-term outcomes of endovascular treatment for aortic pseudoaneurysm in patients with Behçet's disease. Vascular 2023; 31:350-358. [PMID: 34910597 DOI: 10.1177/17085381211063038] [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: 11/15/2022]
Abstract
OBJECTIVES Behçet's disease (BD) is a multisystem inflammatory disorder with unknown etiology, and its aneurysmal lesions are associated with high mortality due to the high risk of rupture. This study intended to further explore the long-term safety and efficacy of endovascular therapy for BD-related aortic pseudoaneurysm (BAP). METHODS From January 2009 to May 2021, 17 BAP patients who underwent endovascular repair were retrospectively identified and enrolled. Adequate immunosuppressive treatment was instituted before and after endovascular treatment unless emergency surgery was required. The patients were followed up at 3, 6, and 12 months and yearly after the primary endovascular intervention by computed tomography angiography (CTA) examination. RESULTS Nineteen BAPs were identified among 17 patients. BAPs located at the aortic arch were found in three patients (17.6%), descending thoracic aorta in 5 (29.4%), and abdominal aorta in 10 (58.8%; suprarenal abdominal aorta in 2 [11.8%], and infrarenal abdominal aorta in 8 [47.1%]). The mean ESR during admission was 56.5 ± 24.9 mm/h (range = 30.0-120.0 mm/h), which fell to 22.7 ± 18.4 mm/h (range = 2.0-74.0 mm/h) before the endovascular intervention (p < 0.001). The rate of favorable immunosuppressive control before intervention is 76.5% (13/17). Technical success was achieved in all patients. Median follow-up time was 57.0 months (interquartile range [IQR] = 21.3-67.3 months). Pseudoaneurysm recurrence was observed in four patients, type I endoleak in one, pseudoaneurysms sac dilation in one, and external iliac artery occlusion in 1. Two patients died of pseudoaneurysm rupture. Five-year accumulated overall rate, recurrence-free rate, and reintervention-free survival rate of BAP patients were 92.8%, 75.4%, and 71.8%, respectively. CONCLUSION Endovascular treatment in BAP patients seemed to be associated with long-term safety and efficacy with a 5-year overall survival rate of 92.8%. Adequate immunosuppressive treatment was essential for BAP patients to prevent aortic pseudoaneurysm recurrence and improve the prognosis.
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Affiliation(s)
- Lingwei Zou
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Liu
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaolang Jiang
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junhao Jiang
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changpo Lin
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, 92323Zhongshan Hospital, Fudan University, Shanghai, China
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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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Choi SJ, Koo HJ, Kang JW, Ahn SM, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Angiographic patterns and temporal changes of arterial lesions in Behcet's disease. Vascular 2021; 30:1160-1167. [PMID: 34565249 DOI: 10.1177/17085381211046465] [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: 11/15/2022]
Abstract
BACKGROUND Behcet's disease (BD) can entail vascular involvement in various forms including aneurysm. We evaluated the angiographic patterns and changes in arterial lesions over time in BD patients with arterial involvement. METHODS We reviewed the medical records of BD patients diagnosed with arterial lesions between 1995 and 2018. Angiographic patterns were categorized as stenosis, occlusion, dilatation, or aneurysm. Patients were divided according to symptom duration (<5, 5-10, >10 years). Cox proportional-hazards model was used to evaluate the risk factors for vascular progression. RESULTS 47 BD patients had arterial involvement in the following patterns: aneurysm (n = 31), stenosis (n = 17), dilatation (n = 13), and occlusion (n = 8). Aneurysm (70.8%) was the most common pattern in 24 patients with short (<5 years) symptom duration. Stenosis was more common (50.0%) in 12 patients with longer symptom durations (>10 years). In 23 patients with follow-up imaging (median, 5.7 years), eight (34.8%) developed 11 new lesions: stenosis (n = 5), dilatation (n = 1), and aneurysm (n = 5). One stenotic lesion progressed to occlusion, and two dilated lesions progressed to aneurysms. Lower extremity involvement and methotrexate use were associated with arterial progression, with hazard ratios of 5.716 (p = 0.029) and 0.101 (p = 0.049), respectively. CONCLUSION In BD patients with arterial involvement, aneurysm was the most common pattern in earlier stages of BD, while stenosis was more common in later stages of BD. Methotrexate use was associated with lower risk of arterial lesion progression.
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Affiliation(s)
- Su Jin Choi
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Min Ahn
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Seon Oh
- Department of Information Medicine, 65526Asan Medical Center, Seoul, South Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang-Keun Lee
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bin Yoo
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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10
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Factors influencing the recurrence of arterial involvement after surgical repair in Behçet disease. J Vasc Surg 2020; 72:1761-1769. [DOI: 10.1016/j.jvs.2020.01.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
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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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Belmir H, Azghari A, Sedki N. Pseudoaneurysm of external iliac artery after extracorporeal shock wave lithotripsy revealing Behçet disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:473-477. [PMID: 32923751 PMCID: PMC7475517 DOI: 10.1016/j.jvscit.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/03/2020] [Indexed: 12/29/2022]
Abstract
Extracorporeal shock wave lithotripsy (ESWL) can lead to rare but severe arterial complications. The causal relationship of ESWL with arterial pseudoaneurysm formation in a patient with Behçet disease is discussed. A 35-year-old man presented with acute recrudescence of right flank pain caused by ureteral lithiasis immediately after having undergone a last session of ESWL. Abdominal examination revealed a painful pulsatile mass in the right iliac region. Contrast-enhanced computed tomography identified a pseudoaneurysm of the right external iliac artery in a patient with a medical history of Behçet disease. The pseudoaneurysm was treated endovascularly, including the use of a covered stent with intensive immunosuppressive therapy. We obtained successful exclusion of the pseudoaneurysm. This case highlights that arterial pseudoaneurysm may occur after ESWL in patients with Behçet disease. Strict follow-up after ESWL sessions is necessary.
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Affiliation(s)
- Hicham Belmir
- Department of Vascular Surgery, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Amine Azghari
- Department of Vascular Surgery, Mohammed V University, Rabat, Morocco
| | - Nabil Sedki
- Department of Vascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco
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13
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Naouli H, Bouarhroum A, Jiber H. A ruptured abdominal aortic aneurysm in Behçet's disease: A case report. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:300-302. [PMID: 32862990 DOI: 10.1016/j.jdmv.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco.
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco
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14
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Xia S, Song C, Zhang L, Hu W, Li H, Shen Y, Lu Q. Endovascular treatment with in-vitro fenestration and sac filling technique for ruptured thoracoabdominal aortic aneurysm with Behcet's disease. J Cardiothorac Surg 2020; 15:221. [PMID: 32807210 PMCID: PMC7430017 DOI: 10.1186/s13019-020-01252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose We provided an endovascular strategy of treating ruptured aortic aneurysm with Behcet’s Disease. Case report A 25-year-old man was diagnosed ruptured thoracoabdominal aortic aneurysm with Behcet’s Disease according to his eye damage history, high level of ESR and C-reactive protein and the imaging result. We used in-vitro fenestration of the stent-graft combined with in-stent technique to occlude the ruptured aortic aneurysm and preserve the blood supply from the aorta for visceral arteries in emergency. Sac filling technique was used to treat the endoleak to quickly prevent bleeding. The patient kept post-operative immunotherapy for 1 year. Conclusion The patient had a good prognosis in the reduction of the cavity of aortic aneurysm to the normal size without any complications in a year follow-up.
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Affiliation(s)
- Shibo Xia
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Wenping Hu
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Haiyan Li
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Yu Shen
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China.
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Di X, Liu C, Zeng R, Ni L. Endovascular Aortic Repair Is a Viable Strategy for Treatment of Primary Infected Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 63:117-128. [DOI: 10.1016/j.avsg.2018.12.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
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16
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El Bhali H, Zahdi O, Bakkali T, Hormat-Allah M, Sefiani Y, Lekehal B, El Mesnaoui A, Bensaid Y. [False aneurysm of the abdominal aorta revealing Behçet's disease]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:344-349. [PMID: 31474346 DOI: 10.1016/j.jdmv.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis diagnosed on the basis of clinical criteria established by the International Study Group for Behçet's. Vascular involvement is common, affecting both arteries and veins. Aortic localizations are rare and severe and can be life-threatening in case of rupture. Thrombosis is observed but aneurysm or false aneurysm are more common. Computed tomographic angiography is essential for diagnosis and study of the characteristics of aneurysms and false aneurysms. Treatment relies on corticosteroids and immunosuppressive drugs in severe forms supplemented by open or endovascular repair. This latter approach represents a safe and efficient alternative to open surgery, it induces fewer pseudoaneurysms and increases the survival rate especially in association with immunosuppressors. We report a case of Behçet disease revealed by a false aneurysm of the abdominal aorta treated by deployment of a covered stent.
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Affiliation(s)
- H El Bhali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - O Zahdi
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - A El Mesnaoui
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - Y Bensaid
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
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17
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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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18
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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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19
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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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20
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Successful Endovascular Treatment of a Ruptured Popliteal Artery Aneurysm in a Patient with Behcet Disease. Ann Vasc Surg 2018; 53:274.e1-274.e5. [DOI: 10.1016/j.avsg.2018.05.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/21/2022]
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21
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Dawson A, Shivaram GM, Baxter SK, Monroe EJ, Koo KSH. Emergent stent-graft repair of a massive aortic pseudoaneurysm secondary to Behçet's disease in a child. ACTA ACUST UNITED AC 2018; 24:295-297. [PMID: 30179160 DOI: 10.5152/dir.2018.18042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An 11-year-old male with vasculitis was found to have a large abdominal aortic pseudoaneurysm on diagnostic angiography. This report describes endovascular repair of the pseudoaneurysm by stent-graft exclusion. The existing literature surrounding this rare and potentially fatal condition is also reviewed.
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Affiliation(s)
- Allison Dawson
- Department of Physiology and Biology, University of Washington School of Medicine, Missouri, USA
| | - Giri M Shivaram
- Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Missouri, USA
| | - Sarah K Baxter
- Department of Rheumatology, Seattle Children's Hospital, University of Washington, Missouri, USA
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Missouri, USA
| | - Kevin S H Koo
- Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Missouri, USA
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22
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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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23
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Emergent Endovascular Treatment of Thoracoabdominal Aortic Rupture in Behcet's Disease. Ann Vasc Surg 2018; 47:282.e7-282.e11. [DOI: 10.1016/j.avsg.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
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24
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Yamamoto Y, Inoue Y, Ichinose T, Nishizawa M, Igari K, Toyofuku T, Kudo T. Multiple Recurrent Pseudoaneurysms after Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Behçet's Disease. Ann Thorac Cardiovasc Surg 2018; 24:315-319. [PMID: 29332924 PMCID: PMC6300418 DOI: 10.5761/atcs.cr.17-00081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In Behçet’s disease (BD) patients, endovascular repair is a reasonable alternative treatment for aortic aneurysms to avoid postoperative anastomotic pseudoaneurysms. However, there are some complications that may occur after endovascular repair. We herein report the case of a 40-year-old man with active BD developed recurrent aortic pseudoaneurysms at the proximal and distal margins of the stent graft and a femoral puncture site pseudoaneurysm 3 months after endovascular abdominal aortic aneurysm (AAA) repair. The aortic pseudoaneurysms were treated endovascularly, including the use of the chimney technique for the proximal pseudoaneurysm close to the renal arteries and the femoral pseudoaneurysm with surgical excision and reconstruction. Intensive immunosuppressive therapy was initiated immediately after the operation. The patient is in good condition without any complications at 8-month follow-up. This case suggests the utility of the chimney technique and postoperative immediate intensive immunosuppressive therapy in treating recurrent aortic pseudoaneurysms in emergency, active BD patients.
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Affiliation(s)
- Yohei Yamamoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tsuyoshi Ichinose
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masato Nishizawa
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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25
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Zhang SH, Zhang FX. Behcet's disease with recurrent thoracic aortic aneurysm combined with femoral artery aneurysm: a case report and literature review. J Cardiothorac Surg 2017; 12:79. [PMID: 28874203 PMCID: PMC5585960 DOI: 10.1186/s13019-017-0644-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022] Open
Abstract
Background Aneurysm or pseudoaneurysm is the main vascular complication of Behcet’s disease. Most hospitals adopt endovascular treatment. Case presentation We report a case of Behcet’s disease with recurrent thoracic aortic aneurysm combined with femoral artery aneurysm. The patient underwent two rounds of endovascular surgery, but developed new aneurysms immediately after surgery. Eventually, the patient died due to rupture of recurrent aneurysm. Conclusions For vasculo-Behcet’s disease, we suggest performing the operation during the stable period. At the same time, glucocorticoids could be used with immunosuppressants preoperatively and postoperatively.
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Affiliation(s)
- Shi-Huai Zhang
- Department of General surgery, Fuxing Hospital of Captial Medical University, No. 20 of Fuxingmenwai Street, Xicheng District, Beijing, 100038, China.
| | - Fu-Xian Zhang
- Department of Vascular surgery, Shijitan Hospital of Captial Medical University, Beijing, 100038, China
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26
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Padrón Encalada C, Gonzalez Gay M, Zanabili Al-Sibai A, Camblor Santervás L, Alonso Pérez M. Reparación endovascular de seudoaneurisma en aorta infrarrenal. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Atrium Advanta V12 Large Diameter Stent-Graft Applications for Infrarenal Abdominal Aortic Pseudoaneurysms (due to Behcet Disease): Safety and Efficacy. Ann Vasc Surg 2017; 44:197-202. [PMID: 28479445 DOI: 10.1016/j.avsg.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/16/2017] [Accepted: 04/12/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of the study was to determine the safety and effectiveness of Atrium Advanta V12 large diameter stent-graft applications for infrarenal abdominal aortic pseudoaneurysms (due to Behcet disease [BD]). METHODS Data of Advanta V12™ (Atrium Europe B.V, Mijdrecht, the Netherlands) applied 12 female patients (mean age 30.5 ± 6.3, range 26-44) with infrarenal abdominal aortic pseudoaneurysms were analyzed retrospectively. All Advanta V12 large diameter stent grafts were implemented from right or left sided 12F femoral sheaths. Stent grafts with 12-16 mm in size and 29-61 mm in length were utilized. Technical success rate, procedure-related mortality and morbidity, and primary patency rate at 4 years were evaluated. RESULTS Technical success rate was 100%. Neither procedure-related mortality nor morbidity was determined. The mean aortic diameter was 14.0 ± 0.8 mm for pseudoaneurysmatic abdominal aortas. The mean follow-up period was 46.5 ± 40.3 months (range 18-75). During follow-ups, only one recurrent aneurysm has evolved at the stenting site due to patients' withdrawal of immunosuppressive treatment. The advent of a new aneurysm proximal or distal to the stent-graft region or at the femoral access localization was not observed. There were no stent occlusions. Primary patency rate at 4 years was 100%. Complete aneurysm exclusion was achieved 100% at 48 months. CONCLUSIONS The use of Advanta V12 large diameter stent grafts for infrarenal abdominal aortic pseudoaneurysms (due to BD), especially in female patients with small aortic diameter, is safe and efficient. Primary patency rate of the stent grafts at 4 years is excellent.
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28
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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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29
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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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Morita Y, Nomoto K. Contained Rupture of an Aortic Root With Multilobulated Pseudoaneurysm in a Patient With Behçet's Disease. J Cardiothorac Vasc Anesth 2016; 30:1652-1655. [PMID: 27468894 DOI: 10.1053/j.jvca.2016.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Yoshihisa Morita
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Koichi Nomoto
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY.
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31
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Sakata T, Ueda H, Watanabe M, Kohno H, Tamura Y, Abe S, Inage Y, Ikeuchi H, Kanda T, Fujii M, Matsumiya G. Endovascular Treatment for Proximal Anastomotic Pseudoaneurysm after Total Arch Replacement in Behcet's Disease. Ann Vasc Surg 2016; 34:272.e9-272.e12. [DOI: 10.1016/j.avsg.2016.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022]
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32
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Shen C, Li W, Zhang Y, Li Q, Jiao Y, Zhang T, Zhang X. Outcomes of surgery for patients with Behcet's disease causing aortic pseudoaneurysm: a shift from open surgery to endovascular repair. Clinics (Sao Paulo) 2016; 71:302-10. [PMID: 27438562 PMCID: PMC4930659 DOI: 10.6061/clinics/2016(06)03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/22/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Behcet's disease is a form of systematic vasculitis that affects vessels of various sizes. Aortic pseudoaneurysm is one of the most important causes of death among patients with Behcet's disease due to its high risk of rupture and associated mortality. Our study aimed to investigate the outcomes of Behcet's disease patients with aortic pseudoaneurysms undergoing open surgery and endovascular aortic repair. METHODS From January 2003 to September 2014, ten consecutive patients undergoing surgery for aortic pseudoaneurysm met the diagnostic criteria for Behcet's disease. Endovascular repair was the preferred modality and open surgery was performed as an alternative. Systemic immunosuppressive medication was administered after Behcet's disease was definitively diagnosed. RESULTS Eight patients initially underwent endovascular repair and two patients initially underwent open surgery. The overall success rate was 90% and the only failed case involved the use of the chimney technique to reach a suprarenal location. The median follow-up duration was 23 months. There were 7 recurrences in 5 patients. The median interval between operation and recurrence was 13 months. No significant risk factors for recurrence were identified, but a difference in recurrence between treatment and non-treatment with preoperative immunosuppressive medication preoperatively was notable. Four aneurysm-related deaths occurred within the follow-up period. The overall 1-year, 3-year and 5-year survival rates were 80%, 64% and 48%, respectively. CONCLUSIONS Both open surgery and endovascular repair are safe and effective for treating aortic pseudoaneurysm in Behcet's disease patients. The results from our retrospective study indicated that immunosuppressive medication was essential to defer the occurrence and development of recurrent aneurysms.
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Affiliation(s)
- Chenyang Shen
- Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, National Center for Cardiovascular Diseases, Center of Vascular Surgery, Beijing, China
- E-mail:
| | - Weihao Li
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
- #contribute equally to this work
| | - Yongbao Zhang
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
| | - Qingle Li
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
| | - Yang Jiao
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
| | - Tao Zhang
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
| | - Xiaoming Zhang
- Peking University People’s Hospital, Department of Vascular Surgery, Beijing, China
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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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Camargo PABD, Bertanha M, Moura R, Sobreira ML, Jaldin RG, Yoshida RDA, Pimenta REF, Yoshida WB. Correção endovascular de pseudoaneurisma toracoabdominal em paciente com Doença de Behçet. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.01115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A Doença de Behçet é uma doença inflamatória caracterizada por úlceras genitais e orais recorrentes, uveítes e lesões cutâneas. O envolvimento arterial é raro, sendo mais comuns as degenerações aneurismáticas do que as oclusivas. Neste caso clínico, paciente do sexo feminino, em tratamento de doença de Behçet havia 20 anos, iniciou com dor abdominal progressiva por dois meses, com piora súbita importante, foi submetida à tomografia computadorizada, que mostrou pseudoaneurisma toracoabdominal. A paciente foi submetida a tratamento endovascular com sucesso.
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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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Nishimura K, Hamasaki T, Yamamoto S, Kawai T, Sugiura K. Endovascular Treatment of Left Subclavian Artery Pseudoaneurysm after Clavicle Fracture in an Elderly Adult with a 40-Year History of Behçet's Disease. Ann Vasc Dis 2015; 8:328-30. [PMID: 26730261 PMCID: PMC4691510 DOI: 10.3400/avd.cr.15-00082] [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: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 11/13/2022] Open
Abstract
Behçet's disease (BD) is a rare chronic systemic vasculitis of unknown etiology that presents in young adults. We report a very rare case of a left subclavian artery pseudoaneurysm identified after a left clavicle fracture in a 70-year-old man with a 40-year history of intestinal BD. The patient received fixation by banding to treat a fracture after falling from a bed about 5 months previously, and he was referred to our hospital due to the finding of a left subclavian pulsatile mass. As enhanced computed tomography showed a left subclavian artery pseudoaneurysm, it was repaired using an endovascular stent graft.
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Affiliation(s)
- Kengo Nishimura
- Department of Surgery, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Takafumi Hamasaki
- Department of Surgery, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Shuichi Yamamoto
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Tsuyoshi Kawai
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
| | - Kimihiko Sugiura
- Department of Radiology, Tottori Prefectural Kosei Hospital, Kurayoshi, Tottori, Japan
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Balcioglu O, Ertugay S, Bozkaya H, Parildar M, Posacioglu H. Endovascular Repair and Adjunctive Immunosuppressive Therapy of Aortic Involvement in Behçet's Disease. Eur J Vasc Endovasc Surg 2015; 50:593-8. [PMID: 26321000 DOI: 10.1016/j.ejvs.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/08/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Aortic aneurysm is a serious problem in Behçet's disease, but open surgical therapy carries the risk of recurrent pseudoaneurysm. Here the outcomes of endovascular repair and adjunctive immunosuppressive therapy for aortic disease in Behçet's disease are presented. MATERIALS This was a retrospective study. Between 2002 and 2012, nine patients with Behçet's disease (8 male, median age 41 years, range 33-60 years) were treated by endovascular stent grafting for abdominal or thoraco-abdominal aortic pseudoaneurysm. METHODS Computed tomography angiography revealed infrarenal pseudoaneurysm in six (66.6%) patients and suprarenal pseudoaneurysm in three (33.3%). Patients received immunosuppressive therapy with oral prednisolone (60 mg/day) and cyclophosphamide (200 mg/day) for 2 weeks or more before the procedure, and intravenous hydrocortisone (200 mg/day) combined with cyclophosphamide (200 mg/day) for 3 days after the procedure. Thereafter, oral immunosuppressive therapy was continued for 2 years. RESULTS A straight tube graft was implanted in seven patients and a bifurcated graft in two patients. Two stage procedures (debranching before endovascular therapy) were performed in three patients for thoraco-abdominal aortic pseudoaneurysms. Stent grafting was successful in all patients, without any peri-operative complications. However, two patients needed abdominal exploration later: one for seroma around the graft and the other for a fistula between the duodenum and the graft. No recurrence of aneurysm was observed during a mean follow up of 40 ± 16 months. One patient died in the 15th month from a non-vascular cause. CONCLUSIONS Endovascular stent graft implantation and adjunctive immunosuppressive therapy seems to be safe and effective in the treatment of aortic involvement in Behçet's disease, but this approach needs further evaluation.
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Affiliation(s)
- O Balcioglu
- Department of Cardiovascular Surgery, Near East University, North Cyprus, Cyprus
| | - S Ertugay
- Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, Izmir, Turkey.
| | - H Bozkaya
- Department of Radiology, Ege University Medical Faculty Hospital, Izmir, Turkey
| | - M Parildar
- Department of Radiology, Ege University Medical Faculty Hospital, Izmir, Turkey
| | - H Posacioglu
- Department of Cardiovascular Surgery, Ege University Medical Faculty Hospital, Izmir, Turkey
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Gok E, Goksel OS, Guven K, Alpagut IU. Multiple aortic pseudoaneurysms in a patient with Behçet's disease. J Vasc Surg 2015; 62:231. [PMID: 26115924 DOI: 10.1016/j.jvs.2014.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Emre Gok
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Onur Selcuk Goksel
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Koray Guven
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Naouli H, Zrihni Y, Jiber H, Bouarhroum A. [An abdominal aortic aneurysm revealing Behçet's disease]. ACTA ACUST UNITED AC 2014; 39:434-8. [PMID: 25457357 DOI: 10.1016/j.jmv.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/28/2014] [Indexed: 11/26/2022]
Abstract
Behçet's disease is a vasculitis of unknown origin. Vascular lesions predominantly affect veins. Arterial involvement is rare but usually associated with poor prognosis. Aortic syndromes are usually aneurysmal and occasionally reveal Behçet's disease. We report the case of a 46-year-old man whose Behçet's disease was revealed by a sub-renal abdominal aortic aneurysm in pre-rupture state. The diagnosis of this disease was retained based on clinical, biological and radiological criteria. The surgical procedure consisted in the resection of the aneurysmal sac and the interposition of a prosthetic PTFE tube.
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Affiliation(s)
- H Naouli
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc.
| | - Y Zrihni
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
| | - H Jiber
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
| | - A Bouarhroum
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
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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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Recanalization and stenting of a post-thrombotic iliac vein in a patient with Behçet's disease. J Vasc Surg Venous Lymphat Disord 2014; 2:324-6. [PMID: 26993393 DOI: 10.1016/j.jvsv.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/28/2013] [Accepted: 11/09/2013] [Indexed: 11/24/2022]
Abstract
Vascular lesions are frequent in Behçet's disease, and among them, deep venous thrombosis may occur in up to one-third of patients. Treatment is based on immunosuppressive drugs in addition to anticoagulants. We report the case of a young woman who presented with an acute iliofemoral venous thrombosis. Acute treatment with endovascular thrombectomy and catheter-directed fibrinolysis failed, probably because of the inflammatory status of the vessel wall. Recanalization with stenting of the obstructed common femoral and iliac veins 1 year later was successful under immunosuppressive therapy. This case suggests that endovascular treatment of venous thrombosis in Behçet's disease may be conducted successfully in nonactive venous lesions under immunosuppressive therapy.
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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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CT angiography of the upper extremity arterial system: Part 2- Clinical applications beyond trauma patients. AJR Am J Roentgenol 2013; 201:753-63. [PMID: 24059364 DOI: 10.2214/ajr.13.11208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT angiography using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with pathologic abnormalities of the upper extremity arterial system. CONCLUSION Here we focus on the use of this modality in patients with nontraumatic vascular pathologic abnormalities.
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Uchida N, Takasaki T, Takahashi S, Sueda T. Sutureless surgical techniques for arch aneurysm repair in a patient with Behçet's disease. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:859-61. [PMID: 23801174 DOI: 10.5761/atcs.cr.13.02258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In patients with vasculo-Behçet's disease, endovascular stent graft is a reasonable treatment from the viewpoint of prevention of an anastomotic pseudo-aneurysm. We report a case of total arch replacement combined with open stent grafting technique to the downstream aorta and graft inclusion into sino-tubular junction as sutureless surgical techniques for an arch aneurysm in a 42-year-old woman with Behçet's disease. Postoperative computed tomography (CT) showed that the aortic aneurysm had completely disappeared in 11 months after the operation. Open stent grafting technique was effective to prevent anastomotic pseudo-aneurysm formation.
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Affiliation(s)
- Naomichi Uchida
- Division of Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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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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Atypical Vascular Involvement in a Case of Behçet's Disease. Case Rep Surg 2012; 2012:848101. [PMID: 23227411 PMCID: PMC3514815 DOI: 10.1155/2012/848101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/07/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction. Behçet's disease (BD) is a form of vasculitis of unknown etiology which is rare in our environment. It is characterized by a variety of clinical manifestations and usually affects young adults. Recurrent oral and genital ulcers are a characteristic and extremely frequent symptom, but mortality is linked with more significant symptoms such as aortic pseudoaneurysm, pulmonary pseudoaneurysm, and cerebral venous thrombosis. Patient and Method. We present a case of a young male with atypical BD and severe polyvascular involvement (previous cerebral venous thrombosis and current peripheral venous thrombosis, acute ischemia, and peripheral arterial pseudoaneurysm) who required urgent surgical intervention due to a symptomatic external iliac pseudoaneurysm. Result. The pseudoaneurysm was successfully treated, we performed an iliofemoral bypass, and we treated it with steroids and immunosuppressive therapy. Conclusions. These rare clinical manifestations highlight the importance of considering BD in young patients, even in usual cases of vascular intervention, whether arterial or venous in nature.
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49
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Affiliation(s)
- James S T Yao
- Division of Vascular Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Owlia MB, Mehrpoor G. Behcet's Disease: New Concepts in Cardiovascular Involvements and Future Direction for Treatment. ISRN PHARMACOLOGY 2012; 2012:760484. [PMID: 22530146 PMCID: PMC3317002 DOI: 10.5402/2012/760484] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/15/2011] [Indexed: 01/02/2023]
Abstract
Behcet's disease (BD) is the only systemic vasculitis involving both arteries and vein in any sizes. It frequently encounters in rheumatology clinics. It has some major morbidities and even fatal outcomes in some cases. The aim of this paper is to analyze the main concepts on pathophysiology and treatment options in BD, focusing on cardiovascular aspects, thrombosis, and potential future treatment.
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Affiliation(s)
- M. B. Owlia
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - G. Mehrpoor
- Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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