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.
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.
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.
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.