ПРОБЛЕМЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ДЕТЕЙ С АРТЕРИИТОМ ТАКАЯСУ С ПОЗИЦИИ ПЕДИАТРА

Abstract

The purposes of the study were as follows: to perform a comparative analysis of demographic and clinical data in children with Takayasu's arteritis (TA) who underwent surgical treatment of the underlying disease, to determine approaches to surgical interventions and to evaluate its outcomes. Materials and methods of the research: 51 children (boys:girls ratio 1:4.7) aged from 8 months till 17 years old (11 [9; 14] years as median) with a reliable TA diagnosis were observed from February, 2001 till January, 2022. The median age of the TA debut was 11 [9; 14] years. The single-center (I.M. Sechenov University Children's Clinical Hospital with the N.F. Filatov Clinical Institute of Children's Health of the I.M. Sechenov First Moscow State Medical University located in Moscow, Russia) case-control study included 40 patients: Group 1 (n=10) consisted of patients who underwent the surgical intervention, and Group 2 (n=30) consisted of children who have not been indicated for surgical treatment at the end of the follow-up. Patients did not differ statistically significantly in terms of gender (p=1.0), age (p=0.729), disease duration (p=0.542) and duration of follow-up at the hospital (p=0.708). The data that the authors have evaluated included gender, age, duration of the disease, including before the diagnosis was verified, the clinical picture at the onset and the type of TA, data from laboratory and instrumental studies before diagnosis and during follow-up, treatment options, assessment of the TA activity according to the ITAS-A score. Results: the median duration of TA before diagnosis was statistically significantly higher in the Group 1 (p=0.013) and amounted to 23.5 [13; 36] months (9.5 [2; 20] months in the Group 2). The median systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the onset on the TA diagnosis in patients from the Group 1 (165.0 and 110.0 mm Hg, respectively) were statistically significantly higher (p<0.001) than in the Group 2 (116.5 and 65.0 mm Hg, respectively). The arterial hypertension (p<0.001) and headaches (p=0.006) were statically significantly more often in patients from the Group 1, while in patients from the Group 2 the general inflammatory reactions were more typical, such as episodes of fever (80%, p=0.003) and weight loss (33.3%). The median amount of vessels involved in the pathological process at the onset of TA in the Group 1 patients (6.5; [4; 8]) was also statistically significantly higher (p=0.043) than in the Group 2 patients (4; [3 ; 6]). In patients of the 1st Group, the abdominal aorta (90%, p=0.006), descending thoracic aorta (70%, p=0.007) and renal arteries (70%, p<0.001) were affected statistically significantly more often. The Group 1 patients had 14 surgical interventions in total. The median SBP decreased after the 1st surgical intervention from 170 [160; 172] to 130 [105; 145] mm Hg, and the median DBP dropped from 110 [100; 114] to 70 [65; 85] mm Hg. The early postoperative period proceeded favorably after 13 out of total of 14 surgical interventions: in a single patient the neck phlegmon was developed on the same side a week after subclavian-carotid prosthesis on the right side. During the observation period in the hospital there were no deaths recorded in the Group 2. In a single female patient from Group 1 the aneurysm of the anastomosis of the infrarenal aorta ruptured on the 42nd month after the surgical intervention, which has led to her death. Conclusion: the duration of TA before the start of therapy, the extensive damage to the arterial bed, including involvement of the abdominal aorta and renal arteries, the absence or mild severity of the general inflammatory syndrome and arterial hypertension at the onset of the disease increase the likelihood of surgical treatment. The surgical intervention for TA should be carried out against the background of immunosuppressive therapy, according to the strict indications and considering the risk/benefit ratio for each patient.