Treatment of Takayasu Arteritis in the Chronic Stages: An Analysis of 14 Operated Patients

The aim of this study was to evaluate clinical features, angiographic findings, surgical treatment, and the long-term results of surgical procedures in chronic phase of Takayasu Arteritis. Between 1989 and December 2000, 14 young female patients (mean age, 31 years) with occlusive lesions caused by Takayasu Arteritis were observed and treated at our department. All patients met the American College of Rheumatology 1990 criteria of classification of Takayasu Arteritis. Systemic symptoms were reported in fewer than 15%. All patients were evaluated by a routine full aortography. Occlusive disease was dominant (92.8%) and the subclavian and carotid arteries were mostly involved. All our patients underwent surgery and 30 vascular procedures were done. Polytetrafluoroehylene was the most common synthetic graft. The ipsilateral carotid artery was the most common proximal anastomotic site and the ascending aorta was used twice. Follow-up ranged from 1 to 9 years (mean 6 years) and there was no death. All patients had serial duplex and 6 at least one postoperative angiogram. Twenty percent of the bypass procedures were followed by complications. There was no difference between the complication rate using synthetic grafts or autologous veins. The actuarial graft patency rate was 96.4% at one year and 72% at 4 years. At side of the medical treatment which remains, to date, a subject of discussion, the long-term prognosis of Takayasu Arteritis depends on an elective surgical treatment, which requires full and accurate assessment of the lesions, best done by digital full arteriography. Surgical results are excellent with minimal morbidity and mortality.