Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.180139
Jornal Vascular Brasileiro
Original Article

Outcomes of segmental femoral artery pseudoaneurysm in patients with Behçet’s disease: a single center’s experience

Desfechos de pseudoaneurisma de segmento da artéria femoral em pacientes com doença de Behçet: a experiência de um centro

Hussein Mahmoud Khairy; Ahmed Alaa Shaker

http://dx.doi.org/10.1590/1677-5449.180139 J Vasc Bras, vol.18, e20180132, 2019
PDF
SciELO
Downloads: 0
Views: 1233

Abstract

Abstract: Background: Behçet's disease (BD) is an autoimmune condition that involves multiple systems. The most common arterial manifestation in BD patients is pseudoaneurysm, which has higher frequency than aneurysm formation.

Objectives: To clarify the importance of profunda femoris artery in BD pseudoaneurysm, and present a new method for identifying healthy segments for anastomosis.

Methods: Fifteen patients presented at a vascular department with pseudoaneurysms of the common femoral (CFA) and superficial femoral artery (SFA), were diagnosed with BD and underwent surgical intervention at Kasr al Ainy hospitals over 2 years.

Results: All patients were male. The patients ranged in age from 30 to 40 years (mean, 33.8±2.6 years). Mean duration of the disease was 5±3.4 years. Eight (53.3%) CFA graft interpositions, six (40%) mid SFA graft interpositions, and one (6.66) distal SFA graft interposition were performed. Eight (53.3%) of these operations were performed using Dacron graft and sartorius flap, three (20%) were performed with a polytetrafluoroethylene graft, and four (26.66) with a great saphenous vein graft. Two cases (13.33%) were accidentally discovered while four cases (26.66%) had short distance claudication, four cases (26.66%) had pain at rest, and five cases (33.33%) presented with pulsatile swelling correlated with pseudoaneurysm size (p = 0.005). Patients were followed-up over 1 year for new aneurysms and recurrence.

Conclusions: Surgical repair with muscle flap coverage, with or without ligation of profunda femoris artery, does not affect prognosis. An alternative method for identifying healthy segments of femoral artery may be frozen section and examination of the artery to decrease the risk of recurrence at the site of anastomosis.

Keywords

Behçet’s disease, pseudoaneurysm, femoral artery, arteritis

Resumo

RESUMO: Contexto: A doença de Behçet (DB) é uma enfermidade autoimune que envolve múltiplos sistemas. A manifestação arterial mais comum em pacientes com DB é o pseudoaneurisma, que tem uma frequência mais alta do que a formação de aneurismas.

Objetivos: Esclarecer a importância da artéria femoral profunda no pseudoaneurisma por DB e apresentar um novo método para a identificação de segmentos saudáveis para anastomose.

Métodos: Quinze pacientes se apresentaram em um departamento vascular com pseudoaneurismas da artéria femoral comum (AFC) e artéria femoral superficial (AFS), foram diagnosticados com DB e foram submetidos a intervenção cirúrgica em hospitais Kasr al Ainy ao longo de 2 anos.

Resultados: Todos os pacientes eram do sexo masculino. A idade variou de 30 a 40 anos (média, 33,8±2,6 anos). A duração média da doença foi de 5±3,4 anos. Foram realizadas oito (53,3%) interposições de enxerto na AFC, seis (40%) interposições de enxerto na AFS média, e uma (6.66) interposição de enxerto na AFS distal. Oito (53,3%) das cirurgias foram realizadas utilizando enxertos de Dacron e retalho sartório, três (20%) com enxertos de politetrafluoroetileno, e quatro (26,66) com enxertos da veia safena magna. Dois casos (13,33%) foram descobertos ao acaso, ao passo que quatro casos (26,66%) apresentaram claudicação em curta distância, quatro (26,66%) apresentaram dor em repouso, e cinco casos (33,33%) apresentaram com inchaço pulsátil correlacionado com o tamanho do pseudoaneurisma (p = 0.005). Os pacientes foram seguidos por 1 ano para novos aneurismas e recorrência.

Conclusões: O reparo cirúrgico com cobertura de retalho muscular, com ou sem ligadura da artéria femoral profunda, não afeta o prognóstico. Um método alternativo para identificar segmentos saudáveis da artéria femoral pode ser o exame de congelação e a avaliação da artéria para diminuir o risco de recorrência no local da anastomose.
 

Palavras-chave

Doença de Behçet, pseudoaneurisma, artéria femoral, arterite

References

Behcet H. Uber rezidiverende aphtose, durch ein Virus verur- sachte Geschwure am Mund, am Auge und den Genitalien. Dermatol Wochenschr. 1937;36:1152-7.

Balta S, Balta I, Ozturk C, Celik T, Iyisoy A. Behcet’s disease and risk of vascular events. Curr Opin Cardiol. 2016;31(4):451-7. http://dx.doi.org/10.1097/HCO.0000000000000281. PMid:27152661.

Wu XY, Wei JP, Zhao XY, et al. Spontaneous intra- abdominal hemorrhage due to rupture of jejunal artery aneurysm in Behcet disease: case report and literature review. Medicine (Baltimore). 2015;94(45):e1979. http://dx.doi.org/10.1097/MD.0000000000001979. PMid:26559278.

Tascilar K, Melikoglu M, Ugurlu S, Sut N, Caglar E, Yazici H. Vascular involvement in Behcet’s syndrome: a retrospective analysis of associations and the time course. Rheumatology (Oxford). 2014;53(11):2018-22. http://dx.doi.org/10.1093/rheumatology/keu233. PMid:24907156.

Tuzun H, Besirli K, Sayin A, et al. Management of aneurysms in Behcet’s syndrome: an analysis of 24 patients. Surgery. 1997;121(2):150-6. http://dx.doi.org/10.1016/S0039-6060(97)90284-1. PMid:9037226.

Yang SS, Park KM, Park YJ, et al. Peripheral arterial involvement in Behcet’s disease: an analysis of the results from a Korean referral center. Rheumatol Int. 2013;33(8):2101-8. http://dx.doi.org/10.1007/s00296-013-2700-9. PMid:23417141.

International Study Group for Behçet’s Disease. Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet. 1990;335(8697):1078-80. PMid:1970380.

Akiyama K, Hirota J, Ohkado A, Shiina Y. Multivarious clinical manifestations of multiple pseudoaneurysms in Behcet’s disease. J Cardiovasc Surg (Torino). 1998;39(2):175-8. PMid:9639001.

Yurdakul S, Hamuryudan V, Yazici H. Behcet syndrome. Curr Opin Rheumatol. 2004;16(1):38-42. http://dx.doi.org/10.1097/00002281-200401000-00008. PMid:14673387.

Hatemi G, Seyahi E, Fresko I, Talarico R, Hamuryudan V. Behcet’s syndrome: a critical digest of the 2013-2014 literature. Clin Exp Rheumatol. 2014;32(4, Suppl 84):S112-22. PMid:25268667.

Gok E, Goksel OS, Guven K, Alpagut IU. Multiple aortic pseudoaneurysms in a patient with Behcet’s disease. J Vasc Surg. 2015;62(1):231. http://dx.doi.org/10.1016/j.jvs.2014.04.006. PMid:26115924.

Sato T, Matsumoto H, Kimura N, et al. Urgent surgical management of deep femoral artery aneurysm in a patient with pre- vasculo- Behcet status. Ann Vasc Dis. 2015;8(2):116-9. http://dx.doi.org/10.3400/avd.cr.15-00017. PMid:26131034.

Tohme A, Aoun N, El-Rassi B, Ghayad E. Vascular manifestations of Behçet’s disease. Eighteen cases among 140 patients. Joint Bone Spine. 2003;70(5):384-9. PMid:14563470.

Koc Y, Gullu I, Akpek G, et al. Vascular involvement in Behcet’s disease. J Rheumatol. 1992;19(3):402-10. PMid:1578454.

Lakhanpal S, Tani K, Lie JT, Katoh K, Ishigatsubo Y, Ohokubo T. Pathologic features of Behcet’s syndrome: a review of Japanese autopsy registry data. Hum Pathol. 1985;16(8):790-5. http://dx.doi.org/10.1016/S0046-8177(85)80250-1. PMid:4018777.

James DG, Thomson A. Recognition of the diverse cardiovascular manifestation in Behcet’s disease. Am Heart J. 1982;103(3):457-8. http://dx.doi.org/10.1016/0002-8703(82)90298-8. PMid:7064790.

Barlas S. Behcet’s disease. An insight from a vascular surgeon’s point of view. Acta Chir Belg. 1999;6(6):274-81. PMid:10674128.

Basaran M, Sever K, Kafali E, Ugurlucan M, Alpagut U, Dayıoglu E. The vascular manifestations of Behcet’s disease: a case report. Ann Cardiol Angeiol (Paris). 2005;54(2):86-8. http://dx.doi.org/10.1016/j.ancard.2004.02.008. PMid:15828463.

Alpagut U, Ugurlucan M, Dayioglu E. Major arterial involvement and review of Behcet’s disease. Ann Vasc Surg. 2007;21(2):232-9. http://dx.doi.org/10.1016/j.avsg.2006.12.004. PMid:17349371.

Desbois AC, Wechsler B, Resche-Rigon M, et al. Immuno- suppressants reduce venous thrombosis relapse in Behçet’s disease. Arthritis Rheumatol. 2012;64(8):2753-60. http://dx.doi.org/10.1002/art.34450. PMid:22354392.
 

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dcb10470e8825c50303b87a jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections