Disease progression after initial surgical intervention for Takayasu arteritis.

OBJECTIVE

This study was conducted to determine the incidence of disease progression and the need for subsequent revascularization procedures in patients with Takayasu arteritis (TA).

METHODS

From 1980 to 2009, all patients with TA who underwent an initial revascularization procedure for end-organ ischemia were identified. The incidence of subsequent revascularization in another vascular bed or revision of the initial procedure was determined.

RESULTS

Forty patients (36 women; mean age, 35) underwent an initial revascularization procedure. Indications for the initial procedure were hypertension in 20, renal dysfunction in 9, extremity ischemia in 6, and stroke/transient ischemic attack in 5. The initial revascularization consisted of 60 bypass procedures and 4 endovascular interventions. During a mean follow-up of 6.4 years, progression of TA in another vascular bed or stenosis/occlusion of the initial revascularization procedure occurred in 16 patients (40%). Five patients with progression required one procedure, whereas 11 required two or more surgical interventions. Procedures required were renal in 12, cerebrovascular in 8, extremity in 8, aortic reconstruction in 5, and mesenteric in 1. Postoperative/30-day morbidity was 14%, and one operative death occurred. Actuarial survival was 94% at 1 year and 85% at 5 years after the remedial procedure.

CONCLUSIONS

TA progression is common in patients who require revascularization for end-organ ischemia. This finding emphasizes the need for global lifelong vascular surveillance of all patients who undergo surgical intervention for TA. The effect of steroid and immunosuppressive therapy on reducing reoperation requires further study.