Department of Vascular Surgery, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
Department of Vascular Surgery, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
J Vasc Surg. 2020 Nov;72(5):1761-1769. doi: 10.1016/j.jvs.2020.01.076. Epub 2020 May 29.
Arterial involvement in Behçet disease (BD) is rare, and its surgical management is a major concern because of its high recurrence rate. This study evaluated the influence of the surgical technique, device, and immunosuppressive treatment used on the postoperative recurrence in patients with non-pulmonary arterial BD.
A single-center, retrospective study was conducted of 23 patients meeting the international criteria for BD who underwent surgery for arterial involvement between May 1996 and September 2015. Recurrence was defined as the occurrence of arterial aneurysm or thrombosis during follow-up. Perioperative medical treatment and surgical technique used were reported.
There were 47 surgical procedures performed in 23 patients. Mean follow-up was 8.4 ± 7.5 years. Initial arterial lesions were aneurysms and thrombosis in 85% and 15% of cases, respectively. Arterial lesions were aortic and peripheral in 48% and 52% of cases. Recurrence rate was 51%. Recurrences developed within <1 year in 24% of cases and at the same anatomic site in 92% of cases. Among the 24 recurrences, 17 were false aneurysms, 6 were thrombosis, and 1 was a true aneurysm in a different arterial site. To treat the arterial lesion, direct anastomosis was performed in 6 cases; bypass using the saphenous vein, graft, or allograft was performed in 6, 27, and 5 cases, respectively; and stent graft was used in 3 cases. Vascular lesions involved the aorta in 19 cases and a peripheral artery in 28 cases. Preoperative medical treatments, including colchicine, steroids, and immunosuppressants, significantly decreased recurrence rate: 28% (7/25) vs 75% (15/20) in untreated patients (P = .002). The recurrence rate was 42.5% (17/40) in patients treated postoperatively vs 80% (4/5) in untreated patients. The nature of the device used (vein, prosthetic graft, allograft, stent graft, or direct anastomosis) did not change the risk of recurrence. When anastomoses were protected using the prosthetic sleeving technique, the recurrence rate was three times lower (P = .08).
Relapse is a main concern after surgical repair of arterial BD. This study suggests the need for targeted perioperative medical management to reduce the risk of arterial recurrence in BD patients. To this end, a multidisciplinary approach is mandatory. The use of sleeve anastomosis is associated with a numerically lower risk of recurrence. However, further studies are needed to confirm this efficacy.
白塞病（BD）很少累及动脉，由于其高复发率，其手术治疗是一个主要关注点。本研究评估了在非肺部动脉 BD 患者中，手术技术、器械和免疫抑制治疗对术后复发的影响。
本研究为单中心回顾性研究，纳入了 1996 年 5 月至 2015 年 9 月期间因动脉受累而接受手术的 23 名符合 BD 国际标准的患者。复发定义为随访期间出现动脉动脉瘤或血栓形成。报告了围手术期的医疗治疗和所使用的手术技术。
23 名患者共进行了 47 次手术。平均随访时间为 8.4±7.5 年。初始动脉病变分别为动脉瘤和血栓形成，占 85%和 15%。动脉病变分别为主动脉和外周动脉受累，占 48%和 52%。复发率为 51%。24%的复发发生在<1 年内，92%的复发发生在同一解剖部位。在 24 例复发中，17 例为假性动脉瘤，6 例为血栓形成，1 例为不同动脉部位的真性动脉瘤。为治疗动脉病变，直接吻合术 6 例，大隐静脉、移植物或同种异体移植物旁路移植术分别为 6、27 和 5 例，支架移植术 3 例。19 例血管病变累及主动脉，28 例累及外周动脉。包括秋水仙碱、类固醇和免疫抑制剂在内的术前药物治疗显著降低了复发率：未治疗患者为 28%（7/25），而治疗患者为 75%（15/20）（P=0.002）。术后治疗患者的复发率为 42.5%（17/40），而未治疗患者的复发率为 80%（4/5）。所使用的器械（静脉、人工移植物、同种异体移植物、支架移植物或直接吻合术）性质并未改变复发风险。当使用人工套管技术保护吻合口时，复发率降低了三倍（P=0.08）。
动脉 BD 手术后的复发是一个主要关注点。本研究表明，需要进行有针对性的围手术期药物治疗，以降低 BD 患者动脉复发的风险。为此，需要多学科方法。使用套管吻合术与复发风险降低相关，但仍需要进一步研究来证实这一疗效。
