Disease Activity in Takayasu Arteritis Affects Long-Term Graft-Related Outcomes

Abstract

Takayasu arteritis (TA) is a rare inflammatory large-vessel vasculitis of unknown etiology that occasionally requires surgical intervention. There is a paucity of published data on the long-term outcomes of surgical intervention in these patients, with or without active disease. A retrospective review was conducted of patients with TA who underwent open, noncardiac vascular surgery at our institution in three geographic locations between 1994 and 2017. Basic demographics, diagnostic workup, treatment, and outcomes were reviewed. Active disease was defined by National Institutes of Health and Mayo Clinic criteria. Between 1994 and 2017, there were 51 patients with TA who underwent open, noncardiac vascular surgery. Forty-four patients (86%) were female, with a mean age of 38 years (range, 10-72 years). At the time of surgery, 36 patients (77%) were taking steroids, with 23 patients (49%) taking an additional immunosuppressant. Twenty patients (42%) had required prior vascular surgical intervention. Six patients (13%) had an additional autoimmune disorder diagnosis. The most common location for disease was the aorta (86%), with subclavian (80%), carotid (69%), innominate (41%), and renal (33%) arterial lesions also seen. Vascular reconstruction was performed on 82 arterial lesions. The most common location for reconstruction was the carotid artery (28%), followed by the subclavian (22%), aorta (15%), and renal artery (11%). Mean follow-up was 74 months (range, 1-265 months). Early complications (<30 days) occurred in 14 patients (31%). Late complications (>30 days) occurred in 22 patients (49%). There were two perioperative deaths (4%). Eighteen patients (40%) required endovascular and surgical reintervention. The primary and primary assisted graft patency rates were 72% and 89%, respectively. Seventeen patients (35%) had active disease at the time of surgery, and three (18%) of these patients developed graft occlusion and underwent revision. Six patients (35%) with active disease required eight additional graft-related reinterventions. Thirty-one patients (65%) had quiescent disease, with three (10%) patients occluding their reconstruction in follow-up. Four patients (13%) with quiescent disease required four additional graft-related reinterventions. Incidence of graft-related reinterventions was higher in patients with active disease (P = .0497). The outcome of the intervention appears be related to the presence of active disease. Patients with active disease had worse graft-related outcomes compared with patients with quiescent disease.