Hosaka A, Miyata T, Hoshina K, Okamoto H, Shigematsu K, Oshima A
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu-shi, Tokyo, Japan -
Int Angiol. 2014 Oct;33(5):419-25.
Despite improvements in therapeutic modalities, the treatment of arterial aneurysms complicating Behçet's disease (BD) is still challenging. This study examined the long-term prognosis after surgery for arterial aneurysms in BD.
This study included 9 patients with BD (8 men and 1 woman) who underwent surgery for arterial aneurysms between 1989 and 2008. The outcomes after the surgical intervention were assessed, including procedure-related complications and survival.
The initial surgical procedures were performed for aortic or iliac aneurysms in 5 patients and for lower-extremity aneurysms in 4 patients. There was no operative mortality. The mean follow-up period was 135±69 months, ranging from 53 to 259 months. Patients with aortic or iliac aneurysms underwent graft interposition with Dacron prostheses. Their postoperative courses were uneventful, and all patients were alive during the follow-up with no procedure-related complications. Those treated for lower-extremity aneurysms tended to show perioperative and postoperative complications, including aneurysmal degeneration of the autogenous vein graft in 2 patients. One patient who initially underwent surgery for a popliteal artery aneurysm died due to the rupture of a dissecting aortic aneurysm after serial surgical interventions for multiple aneurysms. Concomitant aortic or iliac aneurysms in 2 patients were followed up without any change in size under medical treatment using colchicine and corticosteroids.
Although we cannot draw a firm conclusion because of the small number of cases in the present series, graft interposition can lead to a favorable prognosis in BD patients with aortic or iliac aneurysms, whereas surgical treatment of BD-related lower-extremity aneurysms is frequently associated with short- and long-term postoperative complications. Immunosuppressive therapy might possibly improve treatment outcomes.
尽管治疗方式有所改进，但治疗并发白塞病（BD）的动脉动脉瘤仍具有挑战性。本研究探讨了BD患者动脉动脉瘤手术后的长期预后。
本研究纳入了1989年至2008年间接受动脉动脉瘤手术的9例BD患者（8例男性和1例女性）。评估手术干预后的结果，包括与手术相关的并发症和生存率。
5例患者因主动脉或髂动脉瘤接受了初次手术，4例患者因下肢动脉瘤接受了手术。无手术死亡病例。平均随访期为135±69个月，范围为53至259个月。主动脉或髂动脉瘤患者接受了涤纶人工血管移植术。他们的术后病程平稳，所有患者在随访期间均存活，无手术相关并发症。接受下肢动脉瘤治疗的患者往往出现围手术期和术后并发症，包括2例患者自体静脉移植物动脉瘤样退变。1例最初因腘动脉动脉瘤接受手术的患者在多次动脉瘤系列手术干预后因主动脉夹层动脉瘤破裂死亡。2例合并主动脉或髂动脉瘤的患者在使用秋水仙碱和皮质类固醇药物治疗下进行随访，动脉瘤大小无变化。
尽管由于本系列病例数量较少，我们无法得出确凿结论，但人工血管移植术可使BD合并主动脉或髂动脉瘤患者获得良好预后，而BD相关下肢动脉瘤的手术治疗常伴有短期和长期术后并发症。免疫抑制治疗可能会改善治疗效果。
