Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience
With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascul...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2012-02, Vol.125 (6), p.813-819 |
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| creator | SAADOUN, David LAMBERT, Marc EMMERICH, Joseph CACOUB, Patrice MIRAULT, Tristan RESCHE-RIGON, Mathieu KOSKAS, Fabien CLUZEL, Philippe MIGNOT, Cecile SCHOINDRE, Yoland CHICHE, Laurent HATRON, Pierre-Yves |
| description | With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.111.058032 |
| format | Article |
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This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P<0.001) and C-reactive protein (P<0.001) and fibrinogen (P<0.005) serum levels compared with those without complications.
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.111.058032</identifier><identifier>PMID: 22230484</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Angioplasty - utilization ; Anticoagulants - therapeutic use ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Sedimentation ; C-Reactive Protein - analysis ; Cardiology. Vascular system ; Combined Modality Therapy ; Comorbidity ; Disease-Free Survival ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Endovascular Procedures ; Female ; Fibrinogen - analysis ; Follow-Up Studies ; Humans ; Immunosuppressive Agents - therapeutic use ; Inflammation - blood ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications - blood ; Postoperative Complications - epidemiology ; Postoperative Complications - mortality ; Proportional Hazards Models ; Reoperation - statistics & numerical data ; Retrospective Studies ; Stents - utilization ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Takayasu Arteritis - blood ; Takayasu Arteritis - drug therapy ; Takayasu Arteritis - surgery ; Vascular Grafting - methods ; Vascular Grafting - utilization ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Circulation (New York, N.Y.), 2012-02, Vol.125 (6), p.813-819</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c346t-7fbc6a0072f8b086b71927759f32f3c674c59160227d8af645d2841ad675779d3</citedby><cites>FETCH-LOGICAL-c346t-7fbc6a0072f8b086b71927759f32f3c674c59160227d8af645d2841ad675779d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25522761$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22230484$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SAADOUN, David</creatorcontrib><creatorcontrib>LAMBERT, Marc</creatorcontrib><creatorcontrib>EMMERICH, Joseph</creatorcontrib><creatorcontrib>CACOUB, Patrice</creatorcontrib><creatorcontrib>MIRAULT, Tristan</creatorcontrib><creatorcontrib>RESCHE-RIGON, Mathieu</creatorcontrib><creatorcontrib>KOSKAS, Fabien</creatorcontrib><creatorcontrib>CLUZEL, Philippe</creatorcontrib><creatorcontrib>MIGNOT, Cecile</creatorcontrib><creatorcontrib>SCHOINDRE, Yoland</creatorcontrib><creatorcontrib>CHICHE, Laurent</creatorcontrib><creatorcontrib>HATRON, Pierre-Yves</creatorcontrib><title>Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P<0.001) and C-reactive protein (P<0.001) and fibrinogen (P<0.005) serum levels compared with those without complications.
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.</description><subject>Adult</subject><subject>Angioplasty - utilization</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Sedimentation</subject><subject>C-Reactive Protein - analysis</subject><subject>Cardiology. Vascular system</subject><subject>Combined Modality Therapy</subject><subject>Comorbidity</subject><subject>Disease-Free Survival</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Endovascular Procedures</subject><subject>Female</subject><subject>Fibrinogen - analysis</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Inflammation - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - mortality</subject><subject>Proportional Hazards Models</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Stents - utilization</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Takayasu Arteritis - blood</subject><subject>Takayasu Arteritis - drug therapy</subject><subject>Takayasu Arteritis - surgery</subject><subject>Vascular Grafting - methods</subject><subject>Vascular Grafting - utilization</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtPwzAMgCMEgvH4CygcEKdCHk3ScKumwSYNkGBwrbI0QYEuHUk7sX9P0AaIk2X7sy1_AJxhdIkxx1fDyePweVrOJg_35bhMNXyJWIEo2QEDzEie5YzKXTBACMlMUEIOwGGMbynlVLB9cEAIoSgv8gEIj6YLbVwa3bmVgaVXzTq6CFsLn_rwasIavpgQ-whHvm5XKuq-UQFOfGfCyvjOtR46D2fqXa1V7GEZUsN1Ll7DEt71Tee0-Wbh6HOZGsZrcwz2rGqiOdnGI_B8M5oNx9n04XYyLKeZpjnvMmHnmiuEBLHFHBV8LrAkQjBpKbFUc5FrJjFHhIi6UJbnrCZFjlXNBRNC1vQIXGz2LkP70ZvYVQsXtWka5U3bx0oSzJgsJE2k3JA6qYjB2GoZ3EKFdYVR9W28-m881XC1MZ5mT7dX-vnC1L-TP4oTcL4FkjzV2KC8dvGPYyx9wDH9AmuKjB0</recordid><startdate>20120214</startdate><enddate>20120214</enddate><creator>SAADOUN, David</creator><creator>LAMBERT, Marc</creator><creator>EMMERICH, Joseph</creator><creator>CACOUB, Patrice</creator><creator>MIRAULT, Tristan</creator><creator>RESCHE-RIGON, Mathieu</creator><creator>KOSKAS, Fabien</creator><creator>CLUZEL, Philippe</creator><creator>MIGNOT, Cecile</creator><creator>SCHOINDRE, Yoland</creator><creator>CHICHE, Laurent</creator><creator>HATRON, Pierre-Yves</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120214</creationdate><title>Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience</title><author>SAADOUN, David ; LAMBERT, Marc ; EMMERICH, Joseph ; CACOUB, Patrice ; MIRAULT, Tristan ; RESCHE-RIGON, Mathieu ; KOSKAS, Fabien ; CLUZEL, Philippe ; MIGNOT, Cecile ; SCHOINDRE, Yoland ; CHICHE, Laurent ; HATRON, Pierre-Yves</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c346t-7fbc6a0072f8b086b71927759f32f3c674c59160227d8af645d2841ad675779d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Angioplasty - utilization</topic><topic>Anticoagulants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Sedimentation</topic><topic>C-Reactive Protein - analysis</topic><topic>Cardiology. Vascular system</topic><topic>Combined Modality Therapy</topic><topic>Comorbidity</topic><topic>Disease-Free Survival</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Endovascular Procedures</topic><topic>Female</topic><topic>Fibrinogen - analysis</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Inflammation - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - mortality</topic><topic>Proportional Hazards Models</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Stents - utilization</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Takayasu Arteritis - blood</topic><topic>Takayasu Arteritis - drug therapy</topic><topic>Takayasu Arteritis - surgery</topic><topic>Vascular Grafting - methods</topic><topic>Vascular Grafting - utilization</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SAADOUN, David</creatorcontrib><creatorcontrib>LAMBERT, Marc</creatorcontrib><creatorcontrib>EMMERICH, Joseph</creatorcontrib><creatorcontrib>CACOUB, Patrice</creatorcontrib><creatorcontrib>MIRAULT, Tristan</creatorcontrib><creatorcontrib>RESCHE-RIGON, Mathieu</creatorcontrib><creatorcontrib>KOSKAS, Fabien</creatorcontrib><creatorcontrib>CLUZEL, Philippe</creatorcontrib><creatorcontrib>MIGNOT, Cecile</creatorcontrib><creatorcontrib>SCHOINDRE, Yoland</creatorcontrib><creatorcontrib>CHICHE, Laurent</creatorcontrib><creatorcontrib>HATRON, Pierre-Yves</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SAADOUN, David</au><au>LAMBERT, Marc</au><au>EMMERICH, Joseph</au><au>CACOUB, Patrice</au><au>MIRAULT, Tristan</au><au>RESCHE-RIGON, Mathieu</au><au>KOSKAS, Fabien</au><au>CLUZEL, Philippe</au><au>MIGNOT, Cecile</au><au>SCHOINDRE, Yoland</au><au>CHICHE, Laurent</au><au>HATRON, Pierre-Yves</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2012-02-14</date><risdate>2012</risdate><volume>125</volume><issue>6</issue><spage>813</spage><epage>819</epage><pages>813-819</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>With recent advances in endovascular treatment, percutaneous endoluminal angioplasty has become particularly attractive for arterial lesions of Takayasu arteritis. However, data came from case reports or small series, and the long-term outcome has not been reported. The incidence of potential vascular complications after surgery or endovascular treatment is still to be determined.
This retrospective multicenter study analyzed the results and outcomes of 79 consecutive patients with Takayasu arteritis (median age, 39 years; interquartile range [IQR], 25-50 years; 63 women [79.7%]) who underwent 166 vascular procedures (surgery, 104 [62.7%]; endovascular repair, 62 [37.3%]) for the management of arterial complications. After a follow-up of 6.5 years (IQR, 2.2-11.5 years), 70 complications were observed, including restenosis (n=53), thrombosis (n=7), bleeding (n=6), and stroke (n=4). The overall 1-, 3-, 5-, and 10-year arterial complication-free survival rates were 78% (IQR, 69%-88%), 67% (IQR, 57%-78%), 56% (IQR, 46%-70%), and 45% (IQR, 34%-60%), respectively. Among the 104 surgical procedures, 39 (37.5%) presented a complication compared with 31 of the 62 (50%) with endovascular repair. In multivariate analysis, biological inflammation at the time of revascularization (odds ratio, 7.48; 95% confidence interval, 1.42-39.39; P=0.04) was independently associated with the occurrence of arterial complications after the vascular procedure. Patients who experienced complications had higher erythrocyte sedimentation rates (P<0.001) and C-reactive protein (P<0.001) and fibrinogen (P<0.005) serum levels compared with those without complications.
The overall 5-year arterial complication rate was 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with Takayasu arteritis.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>22230484</pmid><doi>10.1161/CIRCULATIONAHA.111.058032</doi><tpages>7</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2012-02, Vol.125 (6), p.813-819 |
| issn | 0009-7322 1524-4539 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Adult Angioplasty - utilization Anticoagulants - therapeutic use Biological and medical sciences Blood and lymphatic vessels Blood Sedimentation C-Reactive Protein - analysis Cardiology. Vascular system Combined Modality Therapy Comorbidity Disease-Free Survival Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Endovascular Procedures Female Fibrinogen - analysis Follow-Up Studies Humans Immunosuppressive Agents - therapeutic use Inflammation - blood Male Medical sciences Middle Aged Postoperative Complications - blood Postoperative Complications - epidemiology Postoperative Complications - mortality Proportional Hazards Models Reoperation - statistics & numerical data Retrospective Studies Stents - utilization Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Takayasu Arteritis - blood Takayasu Arteritis - drug therapy Takayasu Arteritis - surgery Vascular Grafting - methods Vascular Grafting - utilization Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience |
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