Factors Influencing the Recurrence of Arterial Involvement After Surgical Repair In Behçet'S Disease

Abstract

Introduction: Arterial involvement in Behçet's disease (BD) is rare and its surgical management is a major concern because of the high rate of recurrence as thrombosis or false aneurysm. The aim of this study was to identify factors influencing the postoperative recurrence of arterial lesions in patients with non-pulmonary arterial BD. Methods: Single centre retrospective study conducted in 23 patients meeting the International Study Group of BD criteria, who underwent surgery for arterial involvement between May 1996 and September 2015. Recurrence was defined as the occurrence of arterial aneurysm or thrombosis confirmed by ultrasound or CT-scan during follow-up. The nature of perioperative medical treatment and the surgical technique were reported. Results: Forty-seven surgical procedures were performed with a mean number of 2.4 ± 0.6 procedures in 16 patients with recurrences. Mean follow-up was 8.4±7.5 years. Initial arterial lesions were aneurysms and thrombosis in 85% and 15% of cases respectively. Arterial lesions were aortic in 48% of cases and peripheral in 52%. Recurrence rate was 51%. Recurrences occurred within less than one year in 24%, at the same anatomical site in 92% of cases. Preoperative medical treatment consisting in colchicine or steroids or immunosupressants significantly decreased recurrence rate of arterial lesions: 28% (7/25) versus 75% (15/20) in untreated patients (P = 0.002). The recurrence rate was 42.5% (17/40) in patients treated postoperatively versus 80% (4/5) in untreated patients. The nature of the device used did not change the risk of recurrence (vein, prosthetic graft allograft, stentgraft or direct anastomosis). When anastomosis where protected using prosthetic sleeving technique during surgery, the risk of recurrence was decreased by three (P = 0.034). Conclusion: Relapse is a main concern after surgical repair of arterial BD. But the risk seems to be reduced when a medical treatment is applied with vascular procedure. This study suggests the need for targeted perioperative medical management to reduce the risk of arterial recurrence in BD patients. To this end, a multidisciplinary approach combining rheumatologists and vascular surgeons is mandatory. The use of sleeve anastomosis is associated with a decrease in risk of recurrence in the form of anastomotic pseudo aneurysms and should be generalized when technically feasible. Disclosure: Nothing to disclose