Advertisement

Long-term outcome after surgical intervention and interventional procedures for the management of Takayasu’s arteritis in children

      Objective

      There is little information available on the results of reconstructive arterial surgery for Takayasu’s arteritis in children. This study evaluates midterm to long-term outcome after surgical, as well as interventional, procedures.

      Methods

      From 1984 through 2004, 10 children (5 boys and 5 girls; age, 12.7 ± 2.6 years) with Takayasu’s arteritis were referred to our center. Baseline cardiovascular assessment included contrast angiography (n = 4), magnetic resonance imaging–angiography (n = 3), and combined contrast angiography plus magnetic resonance imaging–angiography (n = 3). Two patients had disease confined to the thoracic aorta, 4 had disease confined to the abdominal aorta, and 4 had combined thoracoabdominal aortic disease. Steno-occlusive lesions were predominant in 92% of cases. Seven patients were maintained on steroid therapy throughout the follow-up period. Eight children underwent complex surgical procedures, 1 patient had balloon dilatation of the renal and mesenteric arteries, and 1 patient had combined vascular surgery with percutaneous transluminal angioplasty. Overall, 24 grafts (polytetrafluoroethylene, Dacron grafts, and cryopreserved homografts) were implanted in various locations.

      Results

      There were no perioperative deaths. Arterial hypertension regressed in all patients, and cardiac function normalized in all 4 patients with dilative cardiomyopathy. Over a 20-year period, 1 patient presented with sudden death and 2 showed nonfatal disease progression, one of whom required surgical reintervention. The occlusion rate was higher in Dacron grafts.

      Conclusions

      Our study shows that despite the extent and severity of vascular lesions, children with Takayasu’s arteritis could benefit from reconstructive surgery, with low mortality, morbidity, and satisfactory long-term results.

      CTSNet classification

      Abbreviations and Acronyms:

      CA (contrast angiography), CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), LRA (left renal artery), LVSF (left ventricular shortening fraction), MRI (magnetic resonance imaging), PTA (percutaneous transluminal angioplasty), PTFE (polytetrafluoroethylene), SMA (superior mesenteric artery), TA (Takayasu’s arteritis), TTE (transthoracic echocardiography)
      To read this article in full you will need to make a payment

      References

        • Sharma B.K.
        • Jain S.
        • Suri S.
        • Numano F.
        Diagnostic criteria for Takayasu’s arteritis.
        Int J Cardiol. 1996; 54: S127-S133
        • Brogan P.A.
        • Dillon M.J.
        Vasculitis from the pediatric perspective.
        Curr Rheum Rep. 2000; 2: 411-416
        • Robbs J.V.
        • Abdool-Carrim A.T.O.
        • Kadwa A.M.
        Arterial reconstruction for non-specific arteritis (Takayasu’s disease).
        Eur J Vasc Surg. 1994; 8: 401-410
        • Ivarsson S.A.
        • Bergqvist D.
        • Lundstrom N.R.
        • Maly E.
        • Nilsson K.O.
        • Wattsgard C.
        Takayasu’s aortitis with renovascular hypertension.
        Acta Paediatr. 1992; 81: 1044-1048
        • Hata A.
        • Noda M.
        • Moriwaki R.
        • Numano F.
        Angiographic findings of Takayasu arteritis.
        Int J Cardiol. 1996; 54: S155-S163
        • Ishikawa K.
        Effects of prednisolone therapy on arterial angiographic features in Takayasu’s disease.
        Am J Cardiol. 1991; 68: 410-413
        • Lupi H.E.
        • Seoane M.
        Takayasu’s arteritis (nonspecific aortoarterities).
        in: Land A. Berkman Y.M. McAllister Jr, H.A. Aortitis clinical, pathologic, and radiographic aspects. Raven Press, New York1986: 173-179
        • Hoffman G.S.
        Takayasu arteritis.
        Int J Cardiol. 1998; 66: S191-S194
        • Tso E.
        • Flamm S.D.
        • White R.D.
        • et al.
        Takayasu arteritis.
        Arthritis Rheum. 2002; 46: 1634-1642
        • Yamada I.
        • Numano F.
        • Suzuki S.
        Takayasu arteritis.
        Radiology. 1993; 188: 89-94
        • Park J.H.
        Conventional and CT angiographic diagnosis of Takayasu arteritis.
        Int J Cardiol. 1996; 54: S135-S141
        • Kumar S.
        • Subramanyan R.
        • Ravi Mandalam K.
        • et al.
        Aneurysmal form of aortoarteritis (Takayasu’s disease).
        Clin Radiol. 1990; 42: 342-347
        • Touré M.K.
        • Pasquier G.
        • Herreman F.
        • Bonnin A.
        • Fouchard J.
        • Houille F.
        Anévrismes au cours de la maladie de Takayasu.
        Arch Mal Coeur. 1982; 75: 695-700
        • Kalangos A.
        • Baldovinos A.
        • Beghetti M.
        • Vala D.
        • Faidutti B.
        Ascending aortic aneurysm associated with aortic insufficiency due to Takayasu’s arteritis.
        Ann Thorac Surg. 1999; 68: 248-250
        • Shaddy R.E.
        • Hawkins J.A.
        Immunology and failure of valved allografts in children.
        Ann Thorac Surg. 2002; 74: 1271-1275
        • Kerr G.S.
        Takayasu’s arteritis.
        Curr Opin Rheumatol. 1994; 6: 32-38
        • Tyagi S.
        • Khan A.A.
        • Kaul U.A.
        • Arora R.
        Percutaneous transluminal angioplasty for stenosis of the aorta due to aortic arteritis in children.
        Pediatr Cardiol. 1999; 20: 404-410
        • Saxena A.
        • Kothari S.S.
        • Sharma J.
        • Juneja R.
        • Srivastava S.
        Percutaneous transluminal angioplasty of the aorta in children with nonspecific aortoarteritis.
        Catheter Cardiovasc Interv. 2000; 49: 419-424
        • Deyu Z.
        • Lisheng L.
        • Ruping D.
        • Haying W.
        • Guozhang L.
        Percutaneous transluminal renal angioplasty in aortoarteritis.
        Int J Cardiol. 1998; 66: S205-S211
        • Rao S.A.
        • Mandalam K.R.
        • Rao V.R.
        • et al.
        Takayasu arteritis.
        Radiology. 1993; 189: 173-179
        • Sharma B.K.
        • Jain S.
        • Bali H.K.
        • et al.
        A follow-up of balloon angioplasty and de-novo stenting in Takayasu arteritis.
        Int J Cardiol. 2000; 75: 147-152
        • Takahashi J.C.
        • Sakai N.
        • Manaka H.
        • et al.
        Multiple supra-aortic stenting for Takayasu arteritis.
        Am J Neuroradiol. 2002; 23: 790-793
        • Park J.H.
        • Han M.C.
        • Kim S.H.
        • et al.
        Takayasu arteritis.
        Am J Roentgenol. 1989; 153: 1069-1074
        • Bali H.K.
        • Jain S.
        • Jain A.
        • et al.
        Stent supported angioplasty in Takayasu arteritis.
        Int J Cardiol. 1998; 66: S213-S217
        • Morales E.
        • Pineda C.
        • Martinez-Lavin M.
        Takayasu’s arteritis in children.
        J Rheumatol. 1991; 18: 1081-1084
        • Ishikawa K.
        • Maetani S.
        Long-term outcome for 120 Japanese patients with Takayasu’s disease.
        Circulation. 1989; 80: 429-437
        • Dabague J.
        • Reyes P.A.
        Takayasu arteritis in Mexico.
        Int J Cardiol. 1996; 54: S103-S109