Skip to main content

Advertisement

SpringerLink
Log in

Surgical strategy for refractory aortitis

  • SPECIAL EDITION
  • Controversies in Surgery for Thoracic Aorta
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur. To prevent such sequelae in the early and late phases, continuous (life-long) as well as perioperative inflammation control using corticosteroid as an initial drug and/or other immunosuppression agents. This decade, instead of the conventional open surgical repairs, endovascular treatments have widely spread, predominantly for stenotic aortic/arterial lesions. In particular, for more difficult patients suffered from more troublesome Behçet disease, endovascular treatments would have greater advantages to avoid more occasionally occurred pseudo-aneurysm on the other parts as well as the surgical suture lines. The key issues on surgical treatment for refractory aortitis are perioperative inflammation control including the long term with corticosteroid and/or immunosuppressive agents, appropriate open surgical or endovascular treatment approaches, and sufficient reinforcement of surgical suture lines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology. Euro Heart J. 2014;35(41):2873–926.

    Article  Google Scholar 

  2. Svensson LG, et al. Inflammatory disease of the aorta: patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S170–5.

    Article  PubMed  Google Scholar 

  3. Takayasu M. A case with peculiar changes of the central retinal vessels. Acta Soc Opthalmol Jpn. 1908;12:554–5.

    Google Scholar 

  4. Numano F, Okawara M, Inomata H, Kobayashi Y. Takayasu’s arteritis. Lancet. 2000;356(9234):1023–5.

    Article  CAS  PubMed  Google Scholar 

  5. Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. Circulation. 2008;118(25):2738–47.

    Article  PubMed  Google Scholar 

  6. Shimizu K, Sano K. Pulseless disease. Clin Surg (Tokyo). 1948;3:377–96.

    Google Scholar 

  7. Inada K, Yokoyama T, Nakata R. Atypical coarctation of the aorta. Angiology. 1963;14:506–17.

    Article  CAS  PubMed  Google Scholar 

  8. Ueda H, Sugiura M, Ito I, Saito Y, Morooka S. Aortic insufficiency associated with aortitis syndrome. Jpn Heart J. 1967;8(2):107–20.

    Article  CAS  PubMed  Google Scholar 

  9. McKusick VA. A form of vascular disease relatively frequent in the Orient. Am Heart J 1962;63:57.

    Article  Google Scholar 

  10. Yajima M, Numano F, Park YB, Sagar S. Comparative studies of patients with Takayasu arteritis in Japan, Korea and India—comparison of clinical manifestations, angiography and HLA-B antigen. Jpn Circ J. 1994;58(1):9–14.

    Article  CAS  PubMed  Google Scholar 

  11. Zheng D, Fan D, Liu L. Takayasu arteritis in China: a report of 530 cases. Heart Vessels Suppl. 1992;7:32–6.

    Article  CAS  PubMed  Google Scholar 

  12. Suwanwela N, Piyachon C. Takayasu arteritis in Thailand: clinical and imaging features. Int J Cardiol. 1996;54:S117–34.

    Article  PubMed  Google Scholar 

  13. Jain SK, Kumai S, Ganguly NK, Sharma BK. Current status of Takayasu arteritis in India. Int J Cardiol. 1996;54:S111–6.

    Article  PubMed  Google Scholar 

  14. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996;54:S155–63.

    Article  PubMed  Google Scholar 

  15. Ueda H, Saito Y, Ito I, Yamaguchi H, Takeda T. Further immunological studies of aortitis syndrome. Jpn Heart J. 1971;12(1):1–21.

    Article  Google Scholar 

  16. Kimura A, Kitamura H, Date Y, Numano F. Comprehensive analysis of HLA genes in Takayasu arteritis in Japan. Int J Cardiol. 1996;54:S61–9.

    Article  PubMed  Google Scholar 

  17. Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu arteriopathy. J Am Coll Cardiol. 1988;12:964–72.

    Article  CAS  PubMed  Google Scholar 

  18. Chung JW, Kim HC, Choi YH, Kim SJ, Lee W, Park JH. Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography. J Vasc Surg. 2007;45(5):906–14.

    Article  PubMed  Google Scholar 

  19. Kobayashi Y, Ishii K, Oda K, Nariai T, Tanaka Y, Numano F, et al. Aortic wall inflammation due to Takayasu arteritis imaged with 18F-FDG PET coregistered with enhanced CT. J Nucl Med. 2005;46(6):917–22.

    PubMed  Google Scholar 

  20. Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, et al. Positron emission tomography as an imaging biomarker in a prospective, longitudinal cohort of patients with large vessel vasculitis. Arthritis Rheumatol. 2017. https://doi.org/10.1002/art.40379.

    Article  Google Scholar 

  21. Kulkarni TP, D’Cruz IA, Gandhi MJ, Dadhich DS. Reversal of renovascular hypertension caused by nonspecific aortitis after corticosteroid therapy. Br Heart J. 1974;36(1):114–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ishikawa K, Yonekawa Y. Regression of carotid stenoses after corticosteroid therapy in occlusive thromboaortopathy (Takayasu’s disease). Stroke. 1987;18(3):677–9.

    Article  CAS  PubMed  Google Scholar 

  23. Ito I. Medical treatment of Takayasu arteritis. Heart Vessels Suppl. 1992;7:133–7.

    Article  CAS  PubMed  Google Scholar 

  24. Watanabe T, Kishi Y, Numano F, Isobe M. Enhanced platelet sensitivity to prostacyclin in patients in an active stage of Takayasu arteritis. Thromb Res. 2001;104(2):77–83.

    Article  CAS  PubMed  Google Scholar 

  25. Numano F, Shimokado K, Kishi Y, Nishiyama K, Türkoglu C, Yajima M, et al. Changes in the plasma levels of thromboxane B2 and cyclic nucleotides in patients with Takayasu disease. Jpn Circ J. 1982;46(1):16–20.

    Article  CAS  PubMed  Google Scholar 

  26. Sharma S, Gupta H, Saxena A, Kothari SS, Taneja K, Guleria S, et al. Results of renal angioplasty in nonspecific aortoarteritis (Takayasu disease). J Vasc Interv Radiol. 1998;9(3):429–35.

    Article  CAS  PubMed  Google Scholar 

  27. Yagura M, Sano I, Akioka H, Hayashi M, Uchida H. Usefulness of percutaneous transluminal angioplasty for aortitis syndrome. Arch Intern Med. 1984;144(7):1465–8.

    Article  CAS  PubMed  Google Scholar 

  28. Rao SA, Mandalam KR, Rao VR, Gupta AK, Joseph S, et al. Takayasu arteritis: initial and long-term follow-up in 16 patients after percutaneous transluminal angioplasty of the descending thoracic and abdominal aorta. Radiology. 1993;189(1):173–9.

    Article  CAS  PubMed  Google Scholar 

  29. Tyagi S, Kaul UA, Nair M, Sethi KK, Arora R, Khalilullah M. Balloon angioplasty of the aorta in Takayasu’s arteritis: initial and long-term results. Am Heart J. 1992;124(4):876–82.

    Article  CAS  PubMed  Google Scholar 

  30. Sharma S, Pinto RJ. Fatal aortic rupture following balloon angioplasty of aortic restenosis in aortoarteritis. Cathet Cardiovasc Diagn. 1995;36(2):132–3.

    Article  CAS  PubMed  Google Scholar 

  31. Baril DT, Carroccio A, Palchik E, Ellozy SH, Jacobs TS, Teodorescu V, et al. Endovascular treatment of complicated aortic aneurysms in patients with underlying arteriopathies. Ann Vasc Surg. 2006;20(4):464–71.

    Article  PubMed  Google Scholar 

  32. Regina G, Bortone A, Impedovo G, De Cillis E, Angiletta D, Marotta V. Endovascular repair of thoracic stent-graft bulging rupture in a patient with multiple thoracic aneurysms due to Takayasu disease. J Vasc Surg. 2007;45(2):391–4.

    Article  PubMed  Google Scholar 

  33. Ishikawa K, Maetani S. Long-term outcome for 120 Japanese patients with Takayasu disease. Clinical and statistical analyses of related prognostic factors. Circulation. 1994;90:1855–60.

    Article  CAS  PubMed  Google Scholar 

  34. Fields CE, Bower TC, Cooper LT, Hoskin T, Noel AA, Panneton JM, et al. Takayasu’s arteritis: operative results and influence of disease activity. J Vasc Surg. 2006;43(1):64–71.

    Article  PubMed  Google Scholar 

  35. Kalangos A, Christenson JT, Cikirikcioglu M, Vala D, Buerge A, Simonet F, Didier D, et al. Long-term outcome after surgical intervention and interventional procedures for the management of Takayasu’s arteritis in children. J Thorac Cardiovasc Surg. 2006;132(3):656–64.

    Article  PubMed  Google Scholar 

  36. Tada Y, Kamiya K, Shindo S, Miyata T, Koyama H, Sato O, et al. Carotid artery reconstruction for Takayasu’s arteritis the necessity of all-autogenous-vein graft policy and development of a new operation. Int Angiol. 2000;19(3):242–9.

    CAS  PubMed  Google Scholar 

  37. Connolly JE, Wilson SE, Lawrence PL, Fujitani RM. Middle aortic syndrome: distal thoracic and abdominal coarctation, a disorder with multiple etiologies. J Am Coll Surg. 2002;194(6):774–81.

    Article  PubMed  Google Scholar 

  38. Makino N, Orita Y, Takeshita A, Nakamura M, Matsui K, Tokunaga K. Coronary arterial involvement in Takayasu’s disease. Jpn Heart J. 1982;23(6):1007–13.

    Article  CAS  PubMed  Google Scholar 

  39. Endo M, Tomizawa Y, Nishida H, Aomi S, Nakazawa M, Tsurumi Y, et al. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg. 2003;125(3):570–7.

    Article  PubMed  Google Scholar 

  40. Ando M, Sasako Y, Okita Y, Tagusari O, Kitamura S, Matsuo H. Surgical considerations of occlusive lesions associated with Takayasu’s arteritis. Jpn J Thorac Cardiovasc Surg. 2000;48(3):173–9.

    Article  CAS  PubMed  Google Scholar 

  41. Furukawa Y, Tamura T, Toma M, Abe M, Saito N, Ehara N, et al. Sirolimus-eluting stent for in-stent restenosis of left main coronary artery in Takayasu arteritis. Circ J. 2005;69(6):752–5.

    Article  PubMed  Google Scholar 

  42. Amir O, Kar B, Civitello AB, Palanichamy N, Shakir A, Delgado RM 3rd. Unprotected left main stent placement in a patient with Takayasu’s arteritis: an unusual solution for an unusual disease. Tex Heart Inst J. 2006;33(2):253–5.

    PubMed  PubMed Central  Google Scholar 

  43. Matsumura K, Hirano T, Takeda K, Matsuda A, Nakagawa T, Yamaguchi N, et al. Incidence of aneurysms in Takayasu’s arteritis. Angiology. 1991;42(4):308–15.

    Article  CAS  PubMed  Google Scholar 

  44. Suzuki A, Amano J, Tanaka H, Sakamoto T, Sunamori M. Surgical consideration of aortitis involving the aortic root. Circulation. 1989;80(Suppl I):222–232.

    Google Scholar 

  45. Ando M, Kosakai Y, Okita Y, Nakano K, Kitamura S. Surgical treatment for aortic regurgitation caused by Takayasu’s arteritis. J Card Surg. 1998;13:202–7.

    Article  CAS  PubMed  Google Scholar 

  46. Matsuura K, Ogino H, Kobayashi J, Ishibashi-Ueda H, Matsuda H, Kitamura S, et al. Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality. Circulation. 2005;112(24):3707–12.

    Article  PubMed  Google Scholar 

  47. Tsunekawa T, Ogino H, Matsuda H, Minatoya K, Sasaki H, Kobayashi J, et al. Composite valve graft replacement of the aortic root: 27 years of experience at one Japanese center. Ann Thorac Surg. 2008;86(5):1510–7.

    Article  PubMed  Google Scholar 

  48. Kaku Y, Aomi S, Tomioka H, Yamazaki K. Surgery for aortic regurgitation and aortic root dilatation in Takayasu arteritis. Asian Cardiovasc Thorac Ann. 2015;23(8):901–6.

    Article  CAS  PubMed  Google Scholar 

  49. Matsuura K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Yagihara T, et al. Surgical outcome of aortic arch repair for patients with Takayasu arteritis. Ann Thorac Surg. 2006;81(1):178–82.

    Article  PubMed  Google Scholar 

  50. Kieffer E, Chiche L, Bertal A, Koskas F, Bahnini A, Blã Try O, et al. Descending thoracic and thoracoabdominal aortic aneurysm in patients with Takayasu’s disease. Ann Vasc Surg. 2004;18(5):505–13.

    Article  PubMed  Google Scholar 

  51. Sawada S, Tanigawa N, Kobayashi M, Morioka N, Kotani K, Senda T, et al. Treatment of Takayasu’s aortitis with self-expanding metallic stents (Gianturco stents) in two patients. Cardiovasc Intervent Radiol. 1994;17(2):102–5.

    Article  CAS  PubMed  Google Scholar 

  52. Sharma BK, Jain S, Bali HK, Jain A, Kumari S. A follow-up study of balloon angioplasty and de-novo stenting in Takayasu arteritis. Int J Cardiol. 2000;75(Suppl 1):S147–52.

    Article  PubMed  Google Scholar 

  53. Bali HK, Bhargava M, Jain AK, Sharma BK. De novo stenting of descending thoracic aorta in Takayasu arteritis: intermediate-term follow-up results. J Invasive Cardiol. 2000;12(12):612–7.

    CAS  PubMed  Google Scholar 

  54. Taketani T, Miyata T, Morota T, Takamoto S. Surgical treatment of atypical aortic coarctation complicating Takayasu’s arteritis–—experience with 33 cases over 44 years. J Vasc Surg. 2005;41(4):597–601.

    Article  PubMed  Google Scholar 

  55. Miyata T, Sato O, Deguchi J, Kimura H, Namba T, Kondo K, et al. Anastomotic aneurysms after surgical treatment of Takayasu arteritis: A 40-year experience. J Vasc Surg. 1998;27:438–45.

    Article  CAS  PubMed  Google Scholar 

  56. Numano F, Kishi Y, Tanaka A, Ohkawara M, Kakuta T, Kobayashi Y. Inflammation and atherosclerosis. Atherosclerotic lesions in Takayasu arteritis. Ann N Y Acad Sci. 2000;902:65–76.

    Article  CAS  PubMed  Google Scholar 

  57. Takeno M. Vascular involvement of Behçet’s disease. In: Ishigatsubo Y, editor. Behçet’s disease. Japan: Springer, 2015. p. 79–100.

    Google Scholar 

  58. Ishido T, Horita N, Takeuchi M, Kawagoe T, Shibuya E, Yamane T, et al. Clinical manifestations of Behçet’s disease depending on sex and age: results from Japanese nationwide registration. Rheumatology (Oxford). 2017;56(11):1918–27.

    Article  Google Scholar 

  59. Liu CW, Ye W, Liu B, Zeng R, Wu W, Dake MD. Endovascular treatment of aortic pseudoaneurysm in Behçet disease. J Vasc Surg. 2009;50:1025–30.

    Article  PubMed  Google Scholar 

  60. Calamiaa KT, Schirmer M, Melikoglu M. Major vessel involvement in Behçet’s disease—an update. Curr Opin Rheumatol. 2011;23:24–31.

    Article  Google Scholar 

  61. Kim SW, Lee DY, Kim MD, Won JY, Park SI, Yoon YN, et al. Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet’s disease. J Vasc Surg. 2014;59:608–14.

    Article  PubMed  Google Scholar 

  62. Ulusan Z, Karadag AS, Tasar M, Kalender M, Darcin OT. Behcet’s disease and cardiovascular involvement: our experience of asymptomatic Behcet’s patients. Cardiovasc J Afr. 2014;25(2):63–6.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Tsuda K, Ohkura K, Shintani T, Saito T, Shiiya N. Endovascular treatment of a ruptured innominate artery aneurysm in Behcet disease. Ann Vasc Surg. 2016;33:230.e1–4.

    Article  Google Scholar 

  64. Hosaka A, Miyata T, Shigematsu H, Shigematsu K, Okamoto H, Ishii S, et al. Long-term outcome after surgical treatment of arterial lesions in Behcet disease. J Vasc Surg. 2005;4:116–21.

    Article  Google Scholar 

  65. Iscan ZH, Vural KM, Bayazit M. Compelling nature of arterial manifestations in Behcet disease. J Vasc Surg. 2005;41(1):53–8.

    Article  PubMed  Google Scholar 

  66. Kalko Y, Basaran M, Aydin U, Kafa U, Basaranoglu G, Yasar T. The surgical treatment of arterial aneurysms in Behcet disease: a report of 16 patients. J Vasc Surg. 2005;42:673–7.

    Article  PubMed  Google Scholar 

  67. Park MC, ong BK, Kwon HM, Hong YS. Surgical outcomes and risk factors for postoperative complications in patients with Behcet’s disease. Clin Rheumatol. 2007;26(9):1475–80.

    Article  PubMed  Google Scholar 

  68. Alpagut U, Ugurlucan M, Dayioglu E. Major arterial involvement and review of Behcet’s disease. Ann Vasc Surg. 2007;21(2):232–9.

    Article  PubMed  Google Scholar 

  69. Jeong DS, Kim KH, Kim JS, Ahn H. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet’s disease. Ann Thorac Surg. 2009;87(6):1775–82.

    Article  PubMed  Google Scholar 

  70. Ha YJ, Jung SY, Lee KH, Jung SJ, Lee SW, Park MC, et al. Long-term clinical outcomes and risk factors for the occurrence of post-operative complications after cardiovascular surgery in patients with Behçet’s disease. Clin Exp Rheumatol. 2012;30(3 Suppl 72):S18–26.

    PubMed  Google Scholar 

  71. Saadoun OD, Asli B, Wechsler B, Houman H, Geri G, Desseaux K, et al. Long-term outcome of arterial lesions in Behcet disease: a series of 101 patients. Medicine (Baltimore). 2012;91:18–24.

    Article  Google Scholar 

  72. Ando M, Okita Y, Sasako Y, Kobayashi J, Tagusari O, Kitamura S. Surgical treatment of Behçet’s disease involving aortic regurgitation. Ann Thorac Surg. 1999;68(6):2136–40.

    Article  CAS  PubMed  Google Scholar 

  73. Azuma T, Yamazaki K, Saito S, Kurosawa H. Aortic valve replacement in Behcet’s disease: surgical modification to prevent valve detachment. Eur J Cardiothorac Surg. 2009;36(4):771–2.

    Article  PubMed  Google Scholar 

  74. Ma WG, Zheng J, Zhu JM, Liu YM, Li M, Sun LZ. Aortic regurgitation caused by Behçet’s disease: surgical experience during an 11-year period. J Card Surg. 2012;27(1):39–44.

    Article  PubMed  Google Scholar 

  75. Tanaka H, Ogino H, Matsuda H, Sasaki H. Reoperation for prosthesis dehiscence caused by aortitis. J Thorac Cardiovasc Surg. 2011;142(5):1274–5.

    Article  PubMed  Google Scholar 

  76. Sakuma K, Akimoto H, Yokoyama H, Iguchi A, Tabayashi K. Cryopreserved aortic homograft replacement in three patients with noninfectious inflammatory vascular disease. Jpn J Thorac Cardiovasc Surg. 2001;49(11):652–5.

    Article  CAS  PubMed  Google Scholar 

  77. Hollander SA, Yasnovsky JR, Reinhartz O, Chan F, Sandborg C, Hunt S, et al. Behcet’s disease and heart transplantation: a word of caution. J Heart Lung Transpl. 2010;29(11):1306–8.

    Article  Google Scholar 

  78. Emmungil H, Yaşar Bilge N, Küçükşahin O, Kılıç L, Okutucu S, Gücenmez S, et al. A rare but serious manifestation of Behçet’s disease: intracardiac thrombus in 22 patients. Clin Exp Rheumatol. 2014;32(4 Suppl 84):S87–92.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Hitoshi Ogino

Authors
  1. Hitoshi Ogino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hitoshi Ogino.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ogino, H. Surgical strategy for refractory aortitis. Gen Thorac Cardiovasc Surg 67, 25–31 (2019). https://doi.org/10.1007/s11748-018-0885-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-018-0885-2

Keywords

Search

Navigation