This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Optimizing the outcome of vascular intervention for Takayasu arteritis. BJS 2014; 101: 43-50.

Published: 23rd December 2013

Authors: A. H. Perera, T. Youngstein, R. G. J. Gibbs, J. E. Jackson, J. H. Wolfe, J. C. Mason et al.

Background

Takayasu arteritis (TA) predisposes to the development of arterial stenoses and aneurysms, and is associated with considerable morbidity and mortality amongst young patients. The aims of this study were to analyse indications and outcomes of surgical intervention, and to assess the potential benefits of immunosuppression and the use of perioperative imaging.

Method

This was a retrospective review of patients with TA referred between 2001 and 2012.

Results

A series of 97 patients with TA, seen at a single tertiary centre, is reported. Immunosuppression was required in 87 patients (90 per cent). Thirty‐seven (38 per cent) underwent 64 procedures: 27 patients underwent 33 open surgical procedures and 20 patients had 31 endovascular procedures. After a median follow‐up of 6 years, the overall success rate was 79 per cent for open surgery (mean graft patency 9·4 years) and 52 per cent for endovascular procedures (P = 0·035). Procedural failure was significantly reduced in patients receiving preoperative immunosuppression, and particularly endovascular procedures (P = 0·001). In addition to clinical examination and measurement of acute‐phase reactants, combination non‐invasive imaging including Doppler ultrasonography, [¹⁸F]fluorodeoxyglucose combined positron emission and computed tomography (CT), magnetic resonance angiography and CT angiography was used to identify arterial lesions, establish the diagnosis and monitor treatment outcomes.

Conclusion

Outcomes of vascular intervention in TA may be improved by detailed preoperative assessment including measurement of disease activity, and by ensuring optimal immunomodulatory therapy before and after the procedure.

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