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
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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