İscan Hakki Zafer, Yigit Gorkem, Cetinkaya Ferit, Erdogan Kemal, Tumer Naim Boran, Ozen Anil, Mavioglu Levent, Unal Ertekin Utku
Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
Department of Cardiovascular Surgery, Yozgat City Hospital, Yozgat, Turkey.
Ann Vasc Surg. 2023 May;92:71-81. doi: 10.1016/j.avsg.2022.12.074. Epub 2022 Dec 30.
Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet disease (VBD). This is a retrospective study evaluating 21 patients diagnosed with VBD who underwent endovascular treatment.
This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and a requirement for reintervention. Secondary outcomes were complications and all causes of mortality.
Twenty-one patients underwent endovascular repair. In this study, 1 balloon-expandable stent for brachial artery aneurysm (4,8%), 1 viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (Thoracic endovascular aortic repair [TEVAR]) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), 1 chimney-TEVAR for saccular arcus thoracic aortic aneurysm (TAA) (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal abdominal aortic aneurysm (AAA) (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), and 6 EVAR for ruptured AAA (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50. 4 ± 10.7 months (8-66 months). The mean aneurysm diameter was 10,7 ± 53 mm. In the follow-up period, 3 patients presented with a hematoma at the insertion site of the sheath (14.3%). There were no early mortalities. Three patients required reintervention (14,3%); 1 of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1 ± 5,7% at 1 year, 85,6 ± 9,7% at 3 years, and 68,4 ± 17,1% at 5 years.
Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.
白塞病（BD）最初由胡卢西·白塞于1937年描述，是一种免疫综合征的慢性复发性炎症过程，血管系统受累称为血管性白塞病（VBD）。这是一项回顾性研究，评估了21例接受血管内治疗的VBD患者。
本单中心研究于2016年1月至2022年1月进行。回顾性分析了我院21例诊断为VBD并接受血管内动脉修复的患者（16例男性，5例女性，中位年龄42岁；范围31至46岁）的早期和中期血管内治疗结果。术后第1个月和第6个月安排随访，此后每6个月随访一次。对于有症状的患者，计划进行影像学检查和额外干预。主要结局是手术成功和再次干预的需求。次要结局是并发症和所有死亡原因。
21例患者接受了血管内修复。在本研究中，1例使用球囊扩张支架治疗肱动脉瘤（4.8%），1例使用Viabahn移植物治疗股动脉瘤（4.8%），2例使用管状腔内移植物治疗破裂的髂动脉瘤（9.5%），1例在主动脉分叉处植入管状腔内移植物（胸主动脉腔内修复术[TEVAR]）治疗肾下腹主动脉闭塞（4.8%），1例使用烟囱式TEVAR治疗囊状胸主动脉瘤（TAA）（4.8%），7例使用TEVAR治疗囊状TAA（33.3%），1例使用腔内腹主动脉瘤修复术（EVAR）治疗完整且有症状的肾下腹主动脉瘤（AAA）（4.8%），1例使用EVAR（主动脉单髂动脉）治疗破裂的髂动脉瘤（4.8%），6例使用EVAR治疗破裂的AAA（28.5%）。技术成功率为100%，平均随访期为50.4±10.7个月（8至66个月）。平均动脉瘤直径为10.7±5.3mm。在随访期间，3例患者在鞘管插入部位出现血肿（14.3%）。无早期死亡病例。3例患者需要再次干预（14.3%）；其中1例因穿刺部位假性动脉瘤接受了开放手术修复（4.8%）。Kaplan-Meier分析显示，1年时无需再次干预的比率为94.1±5.7%，3年时为85.6±9.7%，5年时为68.4±17.1%。
对白塞病尤其是对年轻人血管受累情况的认识可挽救生命。根据早期和中期成功结果以及低发病率和死亡率，血管内治疗结合适当的药物治疗似乎是首选治疗方法。
