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Deng Z, Liang B, Li T, Liu Q, Wang X, Sun X, Ou Z, Zhao L, Xu C, Liu H, Li J. Development and validation of a risk prediction model for valve regurgitation in Behçet's disease. Clin Rheumatol 2024; 43:1711-1721. [PMID: 38536517 DOI: 10.1007/s10067-024-06897-5] [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: 07/27/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND In Behçet's disease (BD), mild-to-severe valvular regurgitation (VR) poses a serious complication that contributes significantly to heart failure and eventually death. The accurate prediction of VR is crucial in the early stages of BD subjects for improved prognosis. Accordingly, this study aimed to develop a nomogram that can detect VR early in the course of BD. METHODS One hundred seventy-two patients diagnosed with Behçet's disease (BD) were conducted to assess cardiac valve regurgitation as the primary outcome. The severity of regurgitation was classified as mild, moderate, or severe. The parameters related to the diagnostic criteria were used to develop model 1. The combination of stepAIC, best subset, and random forest approaches was employed to identify the independent predictors of VR and thus establish model 2 and create a nomogram for predicting the probability of VR in BD. Receiver operating characteristics (ROC) and decision curve analysis (DCA) were used to evaluate the model performance. RESULTS Thirty-four patients experienced mild-to-severe VR events. Model 2 was established using five variables, including arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. In comparison with model 1 (0.635, 95% CI: 0.512-0.757), the ROC of model 2 (0.879, 95% CI: 0.793-0.966) was improved significantly. DCA suggested that model 2 was more feasible and clinically applicable than model 1. CONCLUSION A predictive model and a nomogram for predicting the VR of patients with Behçet's disease were developed. The good performance of this model can help us identify potential high-risk groups for heart failure. Key Points • In this study, the predictors of VR in BD were evaluated, and a risk prediction model was developed for the early prediction of the occurrence of VR in patients with BD. • The VR prediction model included the following indexes: arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. • The risk model that we developed was better and more optimized than the models built with diagnostic criteria parameters, and visualizing and personalizing the model, a nomogram, provided clinicians with an easy and intuitive tool for practical prediction.
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Affiliation(s)
- Zixian Deng
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Benhui Liang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Tangzhiming Li
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Qiyun Liu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Xiaoyu Wang
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Xin Sun
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Ziwei Ou
- Department of Cardiology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Lin Zhao
- Department of Cardiology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Cong Xu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China
| | - Huadong Liu
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China.
| | - Jianghua Li
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, The First Affiliated Hospital, Southern University of Science and Technology, Jinan University), 1017 Dongmen North Road, Shenzhen, Guangdong, China.
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2
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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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3
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Wang H, Shu C, Wang T, He H, Li X, Li Q, Peng Y, Wang L, Sun L. Zone 2/3 lesion and emergency repair as potential mortality predictors of TEVAR for thoracic aortic pseudoaneurysm. J Cardiothorac Surg 2023; 18:299. [PMID: 37880709 PMCID: PMC10599020 DOI: 10.1186/s13019-023-02345-8] [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: 11/26/2022] [Accepted: 08/09/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Thoracic aortic pseudoaneurysm (TAP) is an uncommon but life-threatening condition. The present study aimed to investigate the early and midterm clinical outcome of TAP patients following TEVAR and identify potential mortality predictors. METHODS We retrospectively reviewed a series of 37 eligible patients with TAP admitted to our hospital from July 2010 to July 2020. We explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. RESULTS There were 29 men and 12 women, with the mean age as 59.5 ± 13.0 years (range 30-82). The mean follow-up period was 30.7 ± 28.3 months (range 1-89). For early outcome (≤ 30 days), mortality happened in 3 (8.1%) zone 3 TAP patients versus 0 in zone 4 (p = 0.028); postoperative acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm outcome, survival at 3 months, 1 year and 5 years was 88.8%, 75.9% and 68.3%, which showed significant difference between zone 2/3 versus zone 4 group (56.3% vs. 72.9%, p = 0.013) and emergent versus elective TEVAR group (0.0% versus 80.1%, p = 0.049). Previous stent grafting or esophageal foreign body with Aortoesophageal fistula (AEF), and systemic vasculitis, as etiologies, resulted in encouraging immediate outcome but worse midterm prognosis. CONCLUSION TAP lesions at zone 2/3 and emergent TEVAR predict worse midterm outcomes compared to zone 4 lesions and elective TEVAR. The outcomes are also mainly restricted by the etiology of the TAP.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China.
- Department of Vascular Surgery, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Yuan Peng
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
| | - Likun Sun
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Vascular Diseases Institute of Central South University, Changsha, Hunan, China
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4
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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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5
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Tazi Mezalek Z, Khibri H, El Fari S, Chadli S, Ammouri W, Maamar M, Harmouche H, Adnaoui M. [Vascular manifestations of Behcet's disease]. Rev Med Interne 2023; 44:72-78. [PMID: 36564248 DOI: 10.1016/j.revmed.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet.
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Affiliation(s)
- Z Tazi Mezalek
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc.
| | - H Khibri
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - S El Fari
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc
| | - S Chadli
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc
| | - W Ammouri
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - M Maamar
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - H Harmouche
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - M Adnaoui
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
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İscan HZ, Yigit G, Cetinkaya F, Erdogan K, Tumer NB, Ozen A, Mavioglu L, Unal EU. Early and Midterm Outcomes of Endovascular Treatment in Arterial Manifestations of Vascular Behcet Disease. Ann Vasc Surg 2022; 92:71-81. [PMID: 36587791 DOI: 10.1016/j.avsg.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet disease (VBD). This is a retrospective study evaluating 21 patients diagnosed with VBD who underwent endovascular treatment. METHODS This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and a requirement for reintervention. Secondary outcomes were complications and all causes of mortality. RESULTS Twenty-one patients underwent endovascular repair. In this study, 1 balloon-expandable stent for brachial artery aneurysm (4,8%), 1 viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (Thoracic endovascular aortic repair [TEVAR]) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), 1 chimney-TEVAR for saccular arcus thoracic aortic aneurysm (TAA) (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal abdominal aortic aneurysm (AAA) (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), and 6 EVAR for ruptured AAA (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50. 4 ± 10.7 months (8-66 months). The mean aneurysm diameter was 10,7 ± 53 mm. In the follow-up period, 3 patients presented with a hematoma at the insertion site of the sheath (14.3%). There were no early mortalities. Three patients required reintervention (14,3%); 1 of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1 ± 5,7% at 1 year, 85,6 ± 9,7% at 3 years, and 68,4 ± 17,1% at 5 years. CONCLUSIONS Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.
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Affiliation(s)
- Hakki Zafer İscan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Gorkem Yigit
- Department of Cardiovascular Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - Ferit Cetinkaya
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Kemal Erdogan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Naim Boran Tumer
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Anil Ozen
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Levent Mavioglu
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ertekin Utku Unal
- Department of Cardiovascular Surgery, Hitit University Medical Faculty, Çorum, Turkey
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Kardaş RC, Küçük H. Comment on: Efficacy and safety of tocilizumab in Behçet's syndrome with refractory arterial lesions: a single-centre observational cohort study in China. Rheumatology (Oxford) 2022; 62:e129-e130. [PMID: 36066409 DOI: 10.1093/rheumatology/keac493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rıza Can Kardaş
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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8
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Tazi Mezalek Z, Khibri H, Chadli S, El Fari S, Ammouri W, Harmouche H, Maamar M, Adnaoui M. Vascular complications of Behçet disease. Minerva Med 2022; 112:767-778. [PMID: 35168306 DOI: 10.23736/s0026-4806.21.07490-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological, and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. Venous involvement is significantly more common than arterial disease, and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressants are the recommended first-line treatments in vasculo-Behçet. Furthermore, controlled trials are still needed to assess the role of adding anticoagulation to the treatment regimen, with an accent on new oral anticoagulants. Treatment with anti-TNF alpha agents seems promising, but the management strategies are not clear yet.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco - .,Department of Clinical Hematology, Ibn Sina University Hospital, Rabat, Morocco - .,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco -
| | - Hajar Khibri
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Sarra Chadli
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco
| | - Safae El Fari
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco
| | - Wafaa Ammouri
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Hicham Harmouche
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Mouna Maamar
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
| | - Mohamed Adnaoui
- Department of Internal Medicine, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V. University, Rabat, Morocco
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Lee S, Kang S, Eun Y, Kim H, Lee J, Koh EM, Kim DK, Cha HS. Clinical characteristics and radiographic outcomes of vascular Behçet’s disease involving the aorta or its major branches. Clin Rheumatol 2022; 41:1769-1777. [DOI: 10.1007/s10067-021-06031-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 02/02/2023]
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10
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Chang WC, Went CJ, Lee WL, Lai CH. Image Presentation of a Case Regarding Early Peripheral Arterial Obstructive Disease. J Clin Rheumatol 2021; 27:e281-e282. [PMID: 32501942 DOI: 10.1097/rhu.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wei-Chun Chang
- From the Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Chi-Jen Went
- From the Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung
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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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12
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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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13
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Lin CH, Luo D, Ma HF, Shen Y, Zou J, Guan JL. Clinical characteristics and factors influencing the prognosis of Behçet’s disease complicated with vascular involvement. VASA 2020; 49:309-318. [PMID: 32228221 DOI: 10.1024/0301-1526/a000859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Summary: Background: Vascular Behçet's disease (VBD) might involve all sizes of arterial and venous vessels. Major vascular involvement caused the primary death in Behçet's syndrome (BS). We aimed to investigate the clinical characteristics and factors influencing the prognosis of VBD. Patients and methods: A retrospective analysis of the prospectively collected data of the Shanghai BS database from October 2012 to October 2018 was conducted. Patients who were diagnosed with BS and merged with venous thrombosis, arterial aneurysms, and arterial stenosis/occlusions were enrolled. Results: There were 47 patients with vascular involvement among 836 BS patients, 38 males and 9 females. The numbers of patients with venous thrombosis, arterial aneurysm, and arterial stenosis/occlusion were 25 (53.2 %), 21 (44.7 %), and 12 (25.5 %), respectively. Nearly half of the venous thromboses were located in limbs (n = 22, 46.8 %). Arterial aneurysm was the main form of arterial lesion. Most of the patients (93.6 %) were treated with corticosteroids and immunosuppressants. Late onset of BS or with arterial involvement had lower treatment response. Therapy with biological agents had significantly better results than that in the group without biological treatment (94.1 % vs. 80 %, P = 0.005). Conclusions: VBD showed a male preponderance and more than half of the patients presented with venous thrombosis. Late onset and arterial involvement were associated with poor prognosis. Therapy with biological agents is a viable alternative treatment to improve the prognosis.
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Affiliation(s)
- Chen-Hong Lin
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Hai-Fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, P.R. China
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14
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Eleshra A, Abdelgawwad M, Regal S, Soliman M, Khafagy T. Short-term outcome of primary stent graft for peripheral artery aneurysm in patients with Behçet disease. J Vasc Surg 2020; 73:279-284. [PMID: 32325230 DOI: 10.1016/j.jvs.2020.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Endovascular treatment of peripheral artery aneurysms (PAAs) in patients with Behçet disease is controversial. We report a single-institution experience of primary stent graft repair of PAAs in Behçet patients. METHODS Behçet patients who had endovascular stent graft repair of PAAs at a single center between January 2012 and December 2018 were identified. Demographics, past medical history, cardiovascular risk profile, and perioperative details were analyzed. RESULTS Twenty-two patients (mean age, 38 ± 7 years; 100% male) were included. The distribution of PAAs was external iliac artery in 2 (9%) patients, common femoral artery in 4 (18%) patients, superficial femoral artery in 15 (68%) patients, and above-knee popliteal artery in 1 (5%) patient. Pseudoaneurysm was diagnosed in five (23%) patients. We used antegrade access in the majority of patients (16 [73%]). Technical success was achieved in 21 (95%) patients. The mean hospital stay was 3 ± 2 days. There were no deaths or serious complications, and five (23%) patients experienced access site complications. The mean follow-up was 23 ± 11 months. The early primary and assisted primary patency rate was 91%. However, follow-up computed tomography angiography detected stent graft occlusion in six patients (27%). CONCLUSIONS Stent graft for PAA in patients with Behçet disease had a high early patency rate and minimal morbidity. However, the complication and reintervention rates were high during follow-up, with low surgical conversion.
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Affiliation(s)
- Ahmed Eleshra
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Abdelgawwad
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samer Regal
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mosaad Soliman
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tamer Khafagy
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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15
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Cheng Z, Kang Z, Ji Y, Guo Y. Behcet's disease involved the root of aorta in the treatment with modified Bentall procedure: a case report. J Cardiothorac Surg 2020; 15:30. [PMID: 31996248 PMCID: PMC6990569 DOI: 10.1186/s13019-020-1070-0] [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] [Received: 11/05/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Behcet’s disease (BD) is a multisystemic vasculitis of unknown etiology, the incidence of cardiovascular system involvement is rare, about1–5% (Sakane et al., N Engl J Med 341:1284–91, 1999). BD combined with aortic pseudoaneurysm and aortic valve regurgitation is usually need surgical treatment, but there is controversy about which surgical method to choose. Case presentation We report a case of BD combined with severe aortic valve regurgitation and two giant pseudoaneurysms of the aortic sinus. The patient underwent modified Bentall procedure (MBP) and use oral immunosuppressive as well as corticosteroid strictly, after 8 months follow-up, the patient recovered well. Conclusion For patient with aortic valve regurgitation and ascend aortic pseudoaneurysm caused by BD, we recommend modified Bentall procedure when rheumatism in a stable period. Corticosteroids and immunosuppressive drugs should be used before and after surgery.
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Affiliation(s)
- Zeyi Cheng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zhefeng Kang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yupeng Ji
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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17
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Vural U, Kizilay M, Aglar AA. Coronary Involvement in Behçet's Disease: what are its Risks and Prognosis? (Rare Cases and Literature Review). Braz J Cardiovasc Surg 2019; 34:749-758. [PMID: 31241876 PMCID: PMC6894034 DOI: 10.21470/1678-9741-2019-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.
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Affiliation(s)
- Unsal Vural
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
| | - Mehmet Kizilay
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
| | - Ahmet Arif Aglar
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
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18
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Baptista B, Marto N, Tavares JG, Horta AB, Cunha E Sá D, Gerardo G, Mafra M. Behçet Syndrome and Crohn's Disease: What Are the Differences? Eur J Case Rep Intern Med 2019; 6:001044. [PMID: 30931276 PMCID: PMC6438111 DOI: 10.12890/2019_001044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022] Open
Abstract
Behçet syndrome (BS) is a variable vessel vasculitis that has pleiotropic manifestations. A 43-year-old male with a previous diagnosis of Crohn’s disease (CD) presented with deep venous thrombosis and bilateral superficial femoral artery aneurysms. A diagnosis of BS was made, and the patient was treated aggressively with immunosuppressive therapy and bilateral bypass surgery, attaining a favourable outcome. CD has many features that overlap with BS, and it may be challenging to distinguish between these two conditions, as our case illustrates. Nonetheless, the combination of venous thrombosis and arterial aneurysms should point the clinician towards a diagnosis of BS.
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Affiliation(s)
| | - Natália Marto
- Internal Medicine Department, Hospital da Luz, Lisbon, Portugal
| | | | | | | | | | - Manuela Mafra
- Pathology Department, Hospital da Luz, Lisbon, Portugal
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19
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Affiliation(s)
- Ryusuke Yoshimi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
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20
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Ghang B, Kim JB, Jung SH, Chung CH, Lee JW, Song JM, Kang DH, Kim DH, Yoo B, Choo SJ. Surgical Outcomes in Behcet's Disease Patients With Severe Aortic Regurgitation. Ann Thorac Surg 2018; 107:1188-1194. [PMID: 30315793 DOI: 10.1016/j.athoracsur.2018.08.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/23/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND An optimal treatment for aortic regurgitation in Behcet's disease has not been established. We investigated the effect of operative technique, prosthetic material, and immunomodulation therapy on surgical outcomes. METHODS In this study, 23 patients with Behcet's disease surgically treated for aortic regurgitation were assessed. Significant postoperative events were defined as death, aortic valve or graft-related problem(s), infective endocarditis, disabling stroke, and aortic valve or root reoperation. Surgical procedures were classified as isolated aortic valve replacement, bioprosthetic root replacement, and mechanical root replacement. Allograft root replacements were included in the bioprosthetic root replacement group. RESULTS A total of 40 operations, including 39 aortic valve or root surgeries and 1 orthotopic heart transplantation, were performed on patients confirmed with Behcet's disease. However, the study only reviewed 35 of the 40 cases (4 cases with inadequately documented medical records and 1 heart transplantation case were excluded). Significant adverse events occurred in 8 of 11 (73%) isolated aortic valve replacement, 9 of 12 (75%) bioprosthetic root replacement (5 xenografts and 7 allografts), and 4 of 12 (33%) mechanical root replacement cases. Multivariate analysis revealed that the 1-month postdischarge C-reactive protein level and operative age were independent predictive factors for postoperative event-free survival. Mechanical root replacement was identified as the most significant predictive factor leading to positive outcomes (hazard ratio, 0.147; 95% confidence interval, 0.028 to 0.766; p = 0.023). CONCLUSIONS The findings suggest that mechanical root replacement combined with a low postoperative C-reactive protein level maintained through adjunctive immunomodulation therapy may lead to optimal surgical outcomes in Behcet's disease associated with severe aortic regurgitation.
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Affiliation(s)
- Byeongzu Ghang
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Division of Rheumatology, Department of Internal Medicine, Jeju National University Hospital, Jeju City, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Min Song
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk Hyun Kang
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Hee Kim
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Cai J, Zhang Y, Zou J, Shen Y, Luo D, Bao H, Chen Y, Ye J, Guan JL. Serum uric acid could be served as an independent marker for increased risk and severity of ascending aortic dilatation in Behçet's disease patients. J Clin Lab Anal 2018; 33:e22637. [PMID: 30101545 DOI: 10.1002/jcla.22637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation of serum uric acid (SUA) with risk and dilatation diameter of ascending aortic dilatation (AAD) in Behçet's disease (BD) patients. METHODS Seventeen BD patients complicated with AAD and 20 BD patients without AAD were consecutively enrolled and categorized into AAD group and control group, respectively. Ascending aortic dilatation was determined by two-dimensional doppler echocardiographic examination, and AAD was defined as a diameter of ascending aorta ≥3.8 and <4.4 cm. SUA was detected by quantitative immunoassay method. RESULTS Ascending aortic dilatation patients presented with higher proportion of male patients (P = 0.003), hypertension occurrence (P = 0.036) and increased diameter of ascending aorta (P < 0.001) compared to controls. SUA was elevated in AAD patients compared to controls (P = 0.002), and receiver operating characteristic curve displayed that SUA presented with great predictive value for AAD risk in BD patients with area under curve (AUC) 0.821 (95% CI 0.675-0.966). Pearson's analysis also disclosed that SUA was positively correlated with ascending aortic diameter in total BD patients. However, no difference of CRP (P = 0.219) or ESR (P = 0.320) between AAD patients and controls was observed, and no correlation of CRP (R = -0.150, P = 0.377) or ESR (R = 0.067, P = 0.692) with ascending aortic diameter in total BD patients was discovered either. Further multivariate logistic regression illuminated that SUA was an independent factor predicting AAD risk in BD patients (P = 0.031). CONCLUSIONS Serum uric acid could be served as an independent marker for increased risk and severity of AAD in BD patients.
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Affiliation(s)
- Jianfei Cai
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Yinjia Zhang
- Department of Diagnostic Ultrasound, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Huafang Bao
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Yong Chen
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Jingfen Ye
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital affiliated with Fudan University, Shanghai, China
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Hamouda M, Dakour Aridi H, Lee RE, Dhaliwal JS, Malas MB. Management of tibioperoneal trunk aneurysm in a patient with Behçet disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 4:15-18. [PMID: 29725662 PMCID: PMC5928002 DOI: 10.1016/j.jvscit.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/28/2017] [Indexed: 11/30/2022]
Abstract
Only a few cases of infrapopliteal aneurysms are reported in the literature. These are commonly associated with trauma, infection, and iatrogenic injuries and mostly present as pseudoaneurysms. We report the case of a 44-year-old man with Behçet disease and an 8-cm tibioperoneal trunk aneurysm and discuss the management options of these aneurysms.
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Affiliation(s)
- Mohammed Hamouda
- Johns Hopkins Bayview Vascular and Endovascular Research Laboratory, Department of Surgery, Baltimore, Md
| | - Hanaa Dakour Aridi
- Johns Hopkins Bayview Vascular and Endovascular Research Laboratory, Department of Surgery, Baltimore, Md
| | - Rachel Elizabeth Lee
- Johns Hopkins Bayview Vascular and Endovascular Research Laboratory, Department of Surgery, Baltimore, Md
| | - Jasninder Singh Dhaliwal
- Johns Hopkins Bayview Vascular and Endovascular Research Laboratory, Department of Surgery, Baltimore, Md
| | - Mahmoud B Malas
- Johns Hopkins Bayview Vascular and Endovascular Research Laboratory, Department of Surgery, Baltimore, Md
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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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Zhang Z, Yin K, Lin Y, Guo C, Sun Y, Wang C. Successful management of a giant dissecting aortic aneurysm in a patient with Behcet's disease. J Thorac Dis 2017; 9:E547-E550. [PMID: 28740694 DOI: 10.21037/jtd.2017.05.19] [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: 11/06/2022]
Abstract
Thoracic aortic aneurysm with subsequent dissection is a very rare but dangerous complication of Behcet's disease, which is a systemic syndrome that can involve blood vessels of all sizes. Surgical experience in dealing with this complication in patients with Behcet's disease has been limited. We report a 20-year-old patient with Behcet's disease who presented with a giant dissecting thoracic aortic aneurysm. The patient was successfully treated with an aortic root and arch replacement using a frozen elephant trunk technique. Timely surgical intervention and appropriate long-term medical management are important for these patients.
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Affiliation(s)
- Zhiqi Zhang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kanhua Yin
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi Lin
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Changfa Guo
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yongxin Sun
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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