Long-Term Survival After Surgical Treatment of Patients With Takayasu’s Arteritis

CLINICAL INVESTIGATION REPORTS

http://circ.ahajournals.org/cgi/content/abstract/108/12/1474

Tetsuro Miyata, MD; Osamu Sato, MD; Hiroyuki Koyama, MD; Hiroshi Shigematsu, MD; Yusuke Tada, MD

From the Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan. Dr Sato is presently at the Department of Surgery, Saitama Medical Center, Japan. Dr Tada is presently at the Second Department of Surgery, Yamanashi Medical University, Japan.

Correspondence to Dr T. Miyata, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail miyata-2su@h.u-tokyo.ac.jp
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Received February 6, 2003; de novo received April 10, 2003; revision received July 11, 2003; accepted July 11, 2003.

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.