ABSTRACT
OBJECTIVES: Behcet’s disease is a form of systematic vasculitis that affects vessels of various sizes. Aortic pseudoaneurysm is one of the most important causes of death among patients with Behcet’s disease due to its high risk of rupture and associated mortality. Our study aimed to investigate the outcomes of Behcet’s disease patients with aortic pseudoaneurysms undergoing open surgery and endovascular aortic repair. METHODS: From January 2003 to September 2014, ten consecutive patients undergoing surgery for aortic pseudoaneurysm met the diagnostic criteria for Behcet’s disease. Endovascular repair was the preferred modality and open surgery was performed as an alternative. Systemic immunosuppressive medication was administered after Behcet’s disease was definitively diagnosed. RESULTS: Eight patients initially underwent endovascular repair and two patients initially underwent open surgery. The overall success rate was 90% and the only failed case involved the use of the chimney technique to reach a suprarenal location. The median follow-up duration was 23 months. There were 7 recurrences in 5 patients. The median interval between operation and recurrence was 13 months. No significant risk factors for recurrence were identified, but a difference in recurrence between treatment and non-treatment with preoperative immunosuppressive medication preoperatively was notable. Four aneurysm-related deaths occurred within the follow-up period. The overall 1-year, 3-year and 5-year survival rates were 80%, 64% and 48%, respectively. CONCLUSIONS: Both open surgery and endovascular repair are safe and effective for treating aortic pseudoaneurysm in Behcet’s disease patients. The results from our retrospective study indicated that immunosuppressive medication was essential to defer the occurrence and development of recurrent aneurysms.
Subject(s)
Humans , Male , Adult , Middle Aged , Behcet Syndrome/surgery , Aortic Aneurysm, Abdominal/surgery , Aneurysm, False/surgery , Endovascular Procedures/methods , Postoperative Period , Recurrence , Time Factors , Behcet Syndrome/complications , Behcet Syndrome/mortality , Survival Rate , Retrospective Studies , Treatment Outcome , Aortic Aneurysm, Abdominal/etiology , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Abdominal/drug therapy , Aneurysm, False/etiology , Aneurysm, False/mortality , Aneurysm, False/drug therapy , Blood Vessel Prosthesis Implantation/methods , Immunosuppressive Agents/therapeutic useABSTRACT
Pseudoaneurysm is a rare condition arising from disruption in arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rise due to increase in endovascular procedures, hemodialysis and intravenous drug abuse. Here we report an young male who was found by a NGO worker, lying on roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to emergency department of LN Hospital. He was a rickshaw puller and known drug addict. The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonogrphy. He was referred to CTVS department and admitted there for surgery. In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of femoral artery. In this report the gross and histopathological findings of pseudo-aneurysm of common femoral artery were described in autopsy.