Endovascular treatment of aortic pseudoaneurysm in Behçet disease

• Published in: Journal of vascular surgery Vol. 50; no. 5; pp. 1025 - 1030
• Main Authors: Liu, Chang-Wei, MD, Ye, Wei, MD, Liu, Bao, MD, Zeng, Rong, MD, Wu, Weiwei, MD, Dake, Michael D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2009; Elsevier
• Subjects: Adult; Aneurysm, False - diagnostic imaging; Aneurysm, False - drug therapy; Aneurysm, False - etiology; Aneurysm, False - mortality; Aneurysm, False - surgery; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - drug therapy; Aortic Aneurysm - etiology; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortic Rupture - etiology; Aortography - methods; Behcet Syndrome - complications; Behcet Syndrome - diagnostic imaging; Behcet Syndrome - drug therapy; Behcet Syndrome - mortality; Behcet Syndrome - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Cardiology. Vascular system; Combined Modality Therapy; Diseases of the aorta; Feasibility Studies; Female; Humans; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Medication Adherence; Middle Aged; Prosthesis Design; Reoperation; Secondary Prevention; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Young Adult; Skin disease; Stomatology; Aortic false aneurysm; Cardiovascular disease; Endovascular route; Behçet syndrome; Genital diseases; Arterial disease; Vascular disease; Eye disease; Vasculitis; Treatment; Surgery; Systemic disease; Aortic disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.06.009

Objective This study evaluated the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppressive therapy for aortic pseudoaneurysms in patients with Behçet disease. Methods Between April 2002 and April 2008, 12 pseudoaneurysms (9 involving the intrarenal abdominal aorta, 1 at the suprarenal level, and 2 in the supraceliac aorta) in nine men and one woman with Behçet disease were evaluated at Peking Union Medical Center (PUMC). Three bifurcated stent grafts and seven tubular stent grafts, including two fenestrated stent grafts, were deployed. All 10 patients received immunosuppressive therapy after the implant procedure. Results All patients underwent successful endovascular therapy without major complications during the 30 days immediately after the procedure. One patient with two aneurysms had treatment of only the larger infrarenal symptomatic aneurysm, but the smaller suprarenal pseudoaneurysm was not addressed because of its proximity to mesenteric branches. During a mean follow-up of 25.8 months (range, 6-50 months), nine aneurysms resolved completely in eight patients. The only untreated aneurysm, which coexisted with a treated lesion, remained stable under imaging observation. Three aneurysms recurred in two patients. At 6 months, one patient presented with a new aneurysm at the femoral artery access site for stent graft introduction and another formed at the proximal margin of the stent graft. Despite medical advice, he had stopped immunotherapy. He died from aneurysm rupture 8 months after stent deployment. Another patient with recurrent aneurysmal disease at the distal margin of the primary stent was successfully treated with an additional stent graft. These two were the only patients who did not adhere to taking immunosuppressant medicine after discharge. Conclusion Endovascular stent graft placement combined with immunosuppressive treatment for aortic pseudoaneurysms in Behçet disease is a feasible and effective management option. Long-term immunosuppressive therapy after endovascular repair is important to limit pseudoaneurysm recurrence.