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  • Title: Long-term survival after surgical treatment of patients with Takayasu's arteritis.
    Author: Miyata T, Sato O, Koyama H, Shigematsu H, Tada Y.
    Journal: Circulation; 2003 Sep 23; 108(12):1474-80. PubMed ID: 12952846.
    Abstract:
    BACKGROUND: Surgical interventions have been performed to ameliorate the complications of Takayasu's arteritis. However, the efficacy of surgery to increase long-term survival has not been established. METHODS AND RESULTS: A retrospective review was performed on the survival of 106 consecutive patients with Takayasu's arteritis who underwent surgical treatment during the past 40 years. Their ages ranged from 5 to 69 years (mean+/-SEM, 31.7+/-1.3 years). Survival was compared with the reported results of medically treated patients according to Ishikawa's prognostic classification. There were 12 hospital deaths, and the remaining 94 patients were followed up from 8 months to 41.8 years (mean, 19.8 years). A serious long-term complication was anastomotic aneurysm, with a cumulative incidence at 20 years of 13.8%. Thirty-one late deaths were observed, and the major cause was congestive heart failure. The overall cumulative survival rate at 20 years was 73.5%. The prognostic classification by Ishikawa had little influence on the survival of surgically treated patients. For stage 3 patients, surgery seemed to increase survival; however, surgery-related complications conversely decreased the survival of stage 1 patients. CONCLUSIONS: Surgery seems to increase the long-term survival of patients with stage 3 Takayasu's arteritis, whereas conservative treatment is recommended for those with stage 1 or 2 disease. An anastomotic aneurysm may occur at any time after surgery, and regular follow-up using imaging modalities such as multi-detector CT, MRI, or ultrasonography at least once every several years for the rest of the patient's life is mandatory for the early detection of anastomotic aneurysm.
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