Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Management and Prognosis of Non-Pulmonary Large Arterial Disease in Behcet's Syndrome: A Reappraisal of 25 Patients From a Single Center.
Yazici, Hasan, Besirli, Kazim, Hamuryudan, Vedat, Arslan, Caner, Seyahi, Emire, Tuzun, Hasan
To assess management and prognosis in a cohort of 25 patients with non-pulmonary arterial aneurysms due to Behcet's (BS) syndrome by formally re-assessing their outcome at the present time.
We identified 25 (24 M/1F) BS patients with non-pulmonary aneurysms (n= 23) occlusions (n = 2) between 1996 and 2007. All patients fulfilled the International Study Group Criteria for BS. Aneurysms were demonstrated with CT or MRI after first line USG. Standard by-pass procedures were carried out in all patients except in 4 patients with small asymptomatic non-ruptured saccular aneurysms (2 aortic and 2 carotid arteries) which were treated with only medical therapy. For aneurysms located in the aortic bifurcation we preferred aortobiiliac bypasses. For the 6 extremity aneurysms we were able to ligate arteries. For the other 10 extremity aneurysms we used PTFE grafts for bypass procedures. All patients received immunosuppression with cylophosphamide and corticosteroids before the operation and continued in the postoperative period. All patients were examined between January and December 2010, paying special attention for new and anastomotic aneurysms and graft patency.
There was one death and one lost to follow-up. The remaining 23 (92 %) patients were under follow-up after a mean of 7.4 ± 2.9 years following operation. Patients who had ligated arteries complained of mild to moderate claudication. Four (40 %) PTFE grafts occluded without severe complication. Three patients developed relapsing aneurysms elsewhere and 2 other had recurrence at the initial surgical site.
The surgical management of large non-pulmonary arterial complications of BS is quite satisfactory. The prognosis has significantly improved as compared to what we had previously reported, then a 33% mortality at 4 years, from the same center some years ago (1). When the false aneurysm is in the infrarenal aorta, aortobiiliac bypass is the preferred surgical intervention. Extremity aneurysms can be treated with synthetic graft insertion, but occlusions can be seen. In selected cases ligation can give satisfactory results, however post-operative claudication is common. In some patients with small intact saccular aneurysm surgery may not be necessary. Patients must be prescribed to immunosuppressive therapy with cylophosphamide and corticosteroids before and after the surgical intervention in order to avoid BS activation.
To cite this abstract, please use the following information:
Yazici, Hasan, Besirli, Kazim, Hamuryudan, Vedat, Arslan, Caner, Seyahi, Emire, Tuzun, Hasan; Management and Prognosis of Non-Pulmonary Large Arterial Disease in Behcet's Syndrome: A Reappraisal of 25 Patients From a Single Center. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2393