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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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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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Rahman N, Senanayake E, Mascaro J, Situnayake D, Bishay ES, Patel AJ. Recurrent endobronchial occlusion and aorto-bronchial fistula formation in Behcet's disease. J Cardiothorac Surg 2023; 18:22. [PMID: 36635783 PMCID: PMC9838001 DOI: 10.1186/s13019-023-02145-0] [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: 11/23/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Behcet's disease is a multi-system inflammatory disorder. A small subset of patients with Behcet's develop relapsing polychondritis which is classified as a separate disease known as Mouth and Genital ulcers with inflamed cartilage (MAGIC syndrome). It has previously been observed that this condition can also affect the cartilaginous tissue in the tracheobronchial tree. CASE PRESENTATION We present the case of a 44-year-old lady with Behcet's Disease, Mouth and Genital ulcers with inflamed cartilage (MAGIC) syndrome and an aortic Frozen Elephant Trunk (FET) who presented to hospital with recurrent episodes of left lobar collapse of the lung. During bronchoscopy, we found the presence of multiple inflammatory endobronchial webs occluding segments of the left bronchial tree. Repeated examinations showed evidence that these inflammatory webs were progressing in size, density and location. Furthermore, we noticed herniation of her descending aortic FET into her left bronchial tree forming an aorto-bronchial fistula which was complicated by a graft infection. Her descending aortic FET section was surgically replaced with an open procedure and bronchoscopic interventions attempted to remove the occlusions in her bronchial tree. Despite optimisation of medical management and surgical correction, this patient continued to develop progressive occlusion of her left bronchial tree, resulting in a chronically collapsed left lung. CONCLUSIONS A multi-disciplinary team approach is of paramount importance in order to optimally manage patients with Behcet's disease, balancing immunosuppressive regimens that need close monitoring and titration in the context of potential surgical intervention and the risk for intercurrent infection.
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Affiliation(s)
- Niloy Rahman
- grid.412563.70000 0004 0376 6589Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Eshan Senanayake
- grid.412563.70000 0004 0376 6589Department of Cardiac Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Jorge Mascaro
- grid.412563.70000 0004 0376 6589Department of Cardiac Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Deva Situnayake
- grid.412918.70000 0004 0399 8742Department of Rheumatology, National Behcet’s Centre for Excellence, Birmingham City Hospital, Birmingham, UK
| | - Ehab S. Bishay
- grid.412563.70000 0004 0376 6589Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Akshay J. Patel
- grid.412563.70000 0004 0376 6589Department of Thoracic Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT UK
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Duan L, Lu X, Pan R, Cao D. Recurrent aortic-arch pseudoaneurysm eroding into the left main bronchus following descending thoracic aortic stent repair. J Cardiothorac Surg 2023; 18:11. [PMID: 36611192 PMCID: PMC9826582 DOI: 10.1186/s13019-023-02112-9] [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: 02/26/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Behcet's disease is a form of systematic vasculitis that affects vessels of various sizes anywhere in the body. Aortic pseudoaneurysm is the most hazardous lesion in Behcet's disease and is associated with high mortality rate once rupture. CASE PRESENTATION In this report, we presented a patient with a known history of Behcet's disease, whose recurrent aortic-arch pseudoaneurysm eroding into the left main bronchus was identified after a 4-year duration of thoracic endovascular aortic repair for thoracic descending aortic pseudoaneurysm ruptured into the left lung. Repeated thoracic endovascular aortic repair combined with the chimney stent effectively controlled massive hemoptysis under the life-threatening circumstance, and the patient was in good condition at the 7-year follow-up. CONCLUSIONS Thoracic endovascular aortic repair can be used as an effective and problem-solving treatment approach for thoracic aortic aneurysms eroded into the lung, even recurrent pseudoaneurysm after thoracic endovascular aortic repair in BD patients. Among the imaging methods assessing the technical success, outcome and complications, computed tomography angiography offers a fast, accessible and sensitive imaging modality.
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Affiliation(s)
- Lijun Duan
- grid.430605.40000 0004 1758 4110Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin 130021 China
| | - Xiaoqian Lu
- grid.430605.40000 0004 1758 4110Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin 130021 China
| | - Ruonan Pan
- grid.430605.40000 0004 1758 4110Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin 130021 China
| | - Dianbo Cao
- grid.430605.40000 0004 1758 4110Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin 130021 China
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Fiore A, Piscitelli M, Rabia A, Derbel H, Bergoend E, Avtaar Singh SS, Nappi F. Postinflammatory rupture of right coronary artery ostium complicating Behçet disease. J Card Surg 2022; 37:3432-3435. [PMID: 35866180 DOI: 10.1111/jocs.16771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Behçet disease (BD) is a chronic relapsing inflammatory disease of unknown etiology, characterized by variable clinical manifestations. METHODS A 28-year-old woman with BD Cardiovascular and Bipolar Disorder underwent emergency surgical treatment of ascending aortic pseudoaneurysm for ruptured right coronary ostium.A modified Bentall procedure with tricuspid annuloplasty, surgical thrombectomy, and a single coronary artery bypass using a saphenous vein graft was performed. A biological prosthesis was used initially but subsequently deteriorated. We then successfully performed a valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI). RESULTS The postoperative recovery was uneventful and at follow-up, two years post valve procedure, the patient was completely symptom-free. She remains under long-term medical surveillance. CONCLUSION The management of BD with cardiac involvement must be led by a multidisciplinary team.
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Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France.,Department of Cardiac Surgery, Hopitaux Universitaires Henri Mondor, Creteil, France
| | - Mariantonietta Piscitelli
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Amel Rabia
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Haytham Derbel
- Department of Radiology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Eric Bergoend
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Creteil, France
| | - Sanjeet S Avtaar Singh
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, France
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Wang X, Zhang X, Qiu T, Yang Y, Li Q, Zhang X. Dexamethasone reduces the formation of thoracic aortic aneurysm and dissection in a murine model. Exp Cell Res 2021; 405:112703. [PMID: 34118251 DOI: 10.1016/j.yexcr.2021.112703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/30/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening vascular disease with no effective pharmaceutical therapies currently available. Inflammation plays a key role in the progression of aneurysms. Dexamethasone (DEX), a synthetic glucocorticoid, has showed alleviating effects on cells in vitro from TAAD patients. Here we performed a study aiming at investigating the protective role of DEX in a β-aminopropionitrile monofumarate (BAPN)-induced TAAD mouse model. DEX (dose: 0.04 mg/kg/day) treatment significantly reduced the aortic diameter and inhibited TAAD formation. DEX reduced infiltration of macrophages and neutrophils, apoptosis of vascular smooth muscle cells (VSMCs), expression of metalloproteinase 2/9, and extracellular matrix degradation in BAPN-treated TAAD mice. Furthermore, DEX therapy downregulated the expression of p-p65 in macrophages and VSMCs, which suggested that DEX might ameliorate BAPN-induced TAAD by suppressing NF-κB signaling. Therefore, DEX therapy attenuates the progression of BAPN-induced TAAD murine model and could be used as an effective adjuvant therapy for treating TAAD.
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Affiliation(s)
- Xipeng Wang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
| | - Xiaoping Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
| | - Tao Qiu
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
| | - Yang Yang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
| | - Qingle Li
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China.
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8
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Salimi J, Omrani Z, Cheraghali R. Behcet's disease and multiple arterial aneurysms: 4 case reports. J Surg Case Rep 2021; 2021:rjab200. [PMID: 34055290 PMCID: PMC8159195 DOI: 10.1093/jscr/rjab200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Behcet's disease (BD) is a vasculitis of unknown origin. BD is rare in Western countries and the southern hemisphere and is mainly seen in countries along the Silk Road such as the Middle East and Mediterranean regions including Iran. We report four interesting cases of BD with multiple aneurysms three of which had subclavian aneurysms. We chose different surgical approaches for each of these patients due to the different presentations and unique circumstances of each case. Endovascular stent graft used for patients and we discussed open vs. endovascular treatment for BD aneurysms in the discussion.
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Affiliation(s)
- Javad Salimi
- Vascular and Endovascular Surgery, Liver Transplantation Program, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Omrani
- Department of Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Roozbeh Cheraghali
- Vascular and Endovascular Surgery, Tehran University of Medical Sciences (TUMS), Tehran, 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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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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Behcet's Disease with Upper GI Bleeding. Case Rep Emerg Med 2020; 2020:2983209. [PMID: 32257459 PMCID: PMC7103031 DOI: 10.1155/2020/2983209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/21/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction. Behcet's disease is a multisystem disease. In sub-Saharan Africa, the prevalence of this disease is not known, with only one case report from Ethiopia. Case Presentation. We describe a case of a 29-year-old Ethiopian male who presented to the emergency room of Tikur Anbessa specialized hospital with 4 days history of back pain, recurrent history of oral and genital ulcers, right eye blindness, chronic cerebral vein thrombosis, gastrointestinal bleeding, aortic aneurysm with dissection, and positive pathergy test. He is retrospectively diagnosed with Behcet's disease according to both the International Criteria for Behcet's Disease (ICBD) and the International Study Group (ISG) consensus. Conclusion. Even if Behcet's disease is rare in sub-Saharan Africa, it is important to know the clinical presentation for timely diagnosis and urgent management.
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12
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Qi L, Cai J, Mao D, Wang M, Ge X, Wu W, Jin X, Li C, Hua Y, Li M. Use of contrast-enhanced computed tomographic imaging to diagnose and evaluate Behçet's disease with vascular complications. Exp Ther Med 2019; 18:4265-4272. [PMID: 31777534 PMCID: PMC6862536 DOI: 10.3892/etm.2019.8088] [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: 03/21/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022] Open
Abstract
In the present study, multi-slice CT results of patients with Behçet's disease (BD) and vascular complications were retrospectively evaluated. From January 2016 to May 2018, 45 of 361 patients with BD were diagnosed with vascular involvement. The clinical background, laboratory parameters and response to therapy of those patients were assessed. The following characteristics of vascular aneurysms were analyzed: Maximum diameter, length, wall thickness, borders, luminal changes, mural thrombus, cystic change of the vessel walls, asymmetric bulging of the right part of the aortic wall (RP type) and calcific plaques. The 45 BD patients analyzed included 37 males and 8 females with a median age of 40 years (30–49 years). Significant differences were observed among genders regarding age, ocular disorders and digestive-tract ulceration. A total of 42 aneurysms were identified with a mean diameter of 43 mm. Most aneurysmal walls (88%) were homogeneously enhanced on contrast-enhanced CT. Comparison of groups classified by aortic and larger arterial aneurysms indicated that aneurysms occurring in the aorta were more likely to form a mural thrombus, have a thicker wall (P<0.001) and unclear borders (P=0.036), to be of the RP type (P=0.003) and have a longer extension (P=0.001) compared with those in larger arteries. Unclear border of the aneurysmal wall was the only radiologic predictor correlated with an elevated erythrocyte sedimentation rate (P<0.001). In conclusion, characteristic CT imaging features of aneurysms may help to diagnose vascular involvement of BD and assess its severity, particularly in the absence of the classical clinical manifestations.
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Affiliation(s)
- Lin Qi
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Jianfei Cai
- Department of Rheumatology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Dingbiao Mao
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Ming Wang
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Xiaojun Ge
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Weilan Wu
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Xiu Jin
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Cheng Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Yanqing Hua
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai 201318, P.R. China
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El-Ghobashy N, El-Garf K, Abdo M. Arterial aneurysms in Behçet’s disease patients: Frequency, clinical characteristics and long-term outcome. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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[Spontaneous aortic isthmus aneurysm: Exceptional revelation of Behçet's disease]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:340-343. [PMID: 31474345 DOI: 10.1016/j.jdmv.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/30/2019] [Indexed: 11/23/2022]
Abstract
Arterial involvement in Behçet's disease is rare. The exceptional aortic isthmus location is difficult to treat. We report the case of a young man in whom an aortic isthmus aneurysm revealed Behçet's disease. In this exceptional situation, we opted for classical open surgical repair despite current preference for endovascular treatment.
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Mleyhi S, Lagha A, Ziadi J, Ben Hammamia M, Messai M, Ben Mrad M, Ghédira F, Denguir R. [A rare localization of angio-Behçet revealed by a false aneurism of a gluteal artery treated surgically]. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:228-232. [PMID: 31029279 DOI: 10.1016/j.jdmv.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
Behçet's disease is a rare chronic systemic inflammatory disease. It is more common in Turkey, North Africa and Japan. The incidence of vascular involvement (angio-Behçet) is 7 to 38%. The gluteal localization of angio-Behçet is rarely reported and could be revealed late. Aside from aneurysmal rupture, nerve compression with pain and lower limb impotence could be the main clinical signs. Because of the deep location of the lesion, management of this disease can be difficult. The classic surgical treatment remains the gold-standard especially in case of extreme urgency, non-feasibility of endovascular treatment and especially in case of associated nerve compression. We report the case of a 45-year-old man with a history of pulmonary angio-Behcet, who underwent emergency surgery for a huge false aneurism of a collateral of the hypogastric artery treated via a double anterior and posterior approach with good outcome.
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Affiliation(s)
- S Mleyhi
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie.
| | - A Lagha
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - J Ziadi
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - M Ben Hammamia
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - M Messai
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - M Ben Mrad
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - F Ghédira
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
| | - R Denguir
- Département de chirurgie cardiovasculaire et thoracique, CHU La Rabta, faculté de médecine de Tunis, université de Tunis El Manar, Tunisie
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Djaballah-Ider F, Djeraba Z, Chemli M, Dammene-Debbihe N, Lounis D, Belguendouz H, Medour Y, Chaib S, Touil-Boukoffa C. Influence of corticosteroid therapy on IL-18 and nitric oxide production during Behçet's disease. Inflammopharmacology 2018; 26:725-735. [PMID: 29600486 DOI: 10.1007/s10787-018-0472-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Behçet's disease (BD) is a chronic multisystemic inflammatory disease with complex etiopathogenesis. Th1-proinflammatory cytokines seem to be involved in its pathogenesis. Our current study aims to evaluate interleukin-18 (IL-18) and nitric oxide (NO) involvement in the development of different clinical manifestations of BD as well as to investigate the corticosteroid therapy effect on this production in Algerian patients. METHODS For this purpose, we evaluated in vivo and ex vivo IL-18, interferon-γ (IFN-γ) levels using ELISA and NO production by the Griess' method in naïve-active and corticosteroid-treated BD patients with different clinical manifestations. Additionally, we assessed CD40/CD40L expression by flow cytometrics assay in these groups of patients. RESULTS AND DISCUSSION Our results indicate that IL-18 and nitrite levels were higher in naïve-active BD patients. Interestingly, this high production differed according to the clinical manifestations and was associated with an increased risk of mucocutaneous and vascular involvement. Concerning corticosteroid treated-active BD patients, no difference was observed in this production between each clinical subgroup. However, IFN-γ levels increased in all categories of active patients. Interestingly, corticosteroid therapy reduced significantly these inflammatory mediators regardless of the clinical manifestations studied. In addition, the CD40/CD40L expression differed according to the clinical presentations. CONCLUSION Collectively, our results suggest that concomitant high production of IL-18 and NO in naïve-active BD patients is related to an increased risk of mucocutaneous lesions and vascular involvement. Moreover, the relationship between these two inflammatory markers could constitute a predictable tool of BD clinical presentations and an early factor of therapy efficiency.
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Affiliation(s)
| | - Zineb Djeraba
- Universite des Sciences et de la Technologie Houari Boumediene, Algiers, Algeria
| | - Mourad Chemli
- Service de Medecine Interne, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | | | - Doulkifly Lounis
- Service de Medecine Interne, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | - Houda Belguendouz
- Universite des Sciences et de la Technologie Houari Boumediene, Algiers, Algeria
| | - Yanis Medour
- Service d'Immunologie, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
| | - Samia Chaib
- Service d'Immunologie, Hopital Dr Md Seghir NEKKACHE, Algiers, Algeria
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