[Renal and aortic localizations in Takayasu's disease].

AIM OF THE STUDY

The aim of this work was to study the localizations of Takayasu's disease to the aorta and the renal arteries, the long-term results of their surgical treatment and the evolution of the disease with time.

PATIENTS AND METHODS

From 1972 to 2000, 23 patients (16 females, 7 males) with aortic and/or renal lesions were operated on. Mean age was 19.5 +/- 12.4 years. Despite heavy medical treatment, all had severe and uncontrollable hypertension. Eighteen patients had associated lesions of the aorta and renal arteries, 5 had isolated lesions of the renal artery, 10 had lesions of mesenteric arteries, 6 had lesions of supra-aortic trunks. Percutaneous transluminal angioplasty of the renal artery (ies) was attempted in 4 cases and was unsuccessful in all. Due to bilateral lesions in 12 patients, the surgical treatment consisted of 3 nephrectomies and 32 artery repairs of which 23 were performed by conventional in situ surgery and 9 by extracorporeal repair. An aortic bypass was performed in 7 patients and revascularization of other visceral arteries in 3. The follow-up extends from 1 to 18 years (mean: 5).

RESULTS

There was no mortality. Three postoperative thromboses of repairs occurred: 2 of renal artery and 1 of mesenteric artery. Immediate results on blood pressure control were as follows: complete cure in 18 patients (78%), improvement in 3 (13%) and failure in 2 (9%). During the follow-up, evolution of the disease was observed in 10 patients (43%): 4 repeat stenoses of renal arteries due to aggravation of aortic lesions requiring reoperation in 2 patients, 3 aggravation of aortic lesions requiring an aortic bypass in 1 patient, 1 coronary insufficiency requiring a coronary bypass at 8.5 years. During the long-term follow up, due to secondary anatomical deteriorations, the results of surgery on blood pressure control were as follow: complete cure in 14 patients (61%), improvement in 4 (17%), failure in 5 (22%).

CONCLUSION

Surgical treatment of reno-aortic lesions in Takayasu's disease must be reserved to patients whose arterial hypertension is uncontrollable despite heavy medical treatment. Results are altered by the evolution of the disease either locally or in other territories and that may require several operations. Due to frequently occurring late degeneration of repairs, surgical therapy must be carefully decided and patients' follow-up must be prolonged.