Factors Associated With Need for Revascularisation in Non-coronary Arterial Occlusive Lesions Secondary to Takayasu's Arteritis
Autor: | Javier E. Anaya-Ayala, Hugo Laparra-Escareno, Zeniff Gomez-Arcive, Rene Lizola, Adriana Torres-Machorro, Carlos A. Hinojosa |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Computed Tomography Angiography Takayasu's arteritis Arterial Occlusive Diseases Disease Blood Sedimentation 030204 cardiovascular system & hematology Transient ischaemic attacks Renovascular hypertension 03 medical and health sciences Young Adult 0302 clinical medicine Ischemia Risk Factors medicine Humans Arteritis Retrospective Studies 030203 arthritis & rheumatology medicine.diagnostic_test business.industry Endovascular Procedures Smoking Middle Aged medicine.disease Takayasu Arteritis Surgery Exact test Treatment Outcome Erythrocyte sedimentation rate Disease Progression Female Inflammation Mediators Cardiology and Cardiovascular Medicine business Vasculitis Vascular Surgical Procedures Biomarkers Magnetic Resonance Angiography |
Zdroj: | European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 54(3) |
ISSN: | 1532-2165 |
Popis: | Objective/Background Takayasu's arteritis (TA) is rare inflammatory large vessel form of vasculitis. The objective of this study was to evaluate experience in the management of TA patients and to identify the influence of inflammatory markers and clinical variables associated with disease progression, worsening ischaemic symptoms, and the need for interventions. Methods Demographics, and laboratory and clinical variables in patients that required revascularisation procedures were compared with those who had adequate symptomatic control with medical management. Categorical data were analysed with Fisher's exact test, continuous variables with two-sample t test, and a life table analysis was used to study the recurrence of symptoms in intervened patients. Results From January 1995 to May 2016, 47 patients (mean age 30 years; range 14–59 years) were managed; 44 (94%) were female. During the mean follow-up period of 120 months, 21 (45%) underwent 23 procedures (17 of these [74%] open, six [26%] endovascular). From the intervened group, eight (38%) patients presented with transient ischaemic attacks, five (24%) with renovascular hypertension, and four (19%) with upper extremity and four (19%) lower extremity claudication. Comparative analysis demonstrated that elevation of erythrocyte sedimentation rate (ESR) at the time of the diagnosis (revascularisation group: median value 28 mm/hour; medical management group: median value 15 mm/hour) was associated with progression of the disease, worsening symptoms, and subsequent need for intervention ( p = .04). Active smoking was a factor connected with the need for revascularisation ( p = .05). Immediate symptomatic improvement occurred in 19 (90%) patients that underwent surgical or endovascular revascularisation. Conclusion Patients with TA who underwent interventions had higher ESR at the time of diagnosis; this factor and active smoking were associated with progression of the disease and worsening ischaemic symptoms despite medical therapy. Revascularisation procedures are effective at relieving symptoms; lifelong surveillance is necessary. |
Databáze: | OpenAIRE |
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