Outcome and influencing factors of bypass and endovascular treatment for Takayasu arteritis

doi:10.3969/j.issn.1006-7795.2015.01.009

Abstract

Abstract: Objective This study aimed to compare endovascular treatment and bypass surgery for Takayasu ateritis(TA), to analyze influencing factors and to provide reference data for the treatment options of Takayasu arteritis and prevention of postoperative complications. Methods This is a retrospective review of patients with TA referred to us between 2002 and 2014. We used the American Rheumatism Association standards published in 1990 as diagnostic criteria.Results Total number of patients who received surgery was 49, including 44 female cases, accounting for 89.8%, the average age was (27.20±10.35) years, the bypass surgery was performed for 27 cases, endovascular treatment was given to 22 cases (7 cases received stent placement, 15 cases received percutaneous transluminal angioplasty, PTA), 61 culprit vessels were treated. The average follow-up period was (50.43±42.708) months (3-148 months), no deaths occurred. The primary patency rates for 3-month, 6-month, 1-year, 3-year, 5-year, 10-year were 97.8%, 95.6%, 88.3%, 79.6%, 76.1% and 57.1%, respectively. The PTA and stent placement, 1-year patency rates were 91.7% and 68.6% (P= 0.045). Only 2 cases had early complications of hemorrhage. Late complications occurred in a total of 13 cases, including 5 cases after endovascular treatment and 8 cases after bypass (P=0.002); Cerebral infarction in 1 case, thromboembolism in 6 cases, and restenosis in 5 cases (stent restenosis in 2 cases, 3 cases had restenosis after PTA), artificial vascular rejection occurred in 1 case. The overall 1-, 3-, 5-, 10-year no complication rates were 88.1%, 79.0%, 75.4% and 51.9%, respectively. The Logistic regression analysis showed that the immune abnormalities in follow-up period were independent risk factors for postoperative complications (OR: 7.596, CI: 1.091-52.884, P= 0.041). Conclusion Endovascular treatment was significantly superior to bypass surgery in terms of late complications; no significant difference was found between bypass surgery and endovascular treatment in long-term patency rate. Abnormalities in immune parameters during the period of follow-up may be independent risk factors of postoperative complications, postoperative immunomodulatory therapy may be particularly important. PTA had a better primary patency than stenting.

Key words: Takayasu arteritis, bypass, endovascular treatment, retrospective study

CLC Number:

R654.3

Xiao Yaowen, Chen Zhong, Yang Yaoguo, Kou Lei, Tang Xiaobin, Wu Zhangmin, Liu Hui, Wu Qinghua. Outcome and influencing factors of bypass and endovascular treatment for Takayasu arteritis[J]. Journal of Capital Medical University, 2015, 36(1): 45-52.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.01.009

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I1/45

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