Interventions Related to Takayasu Arteritis, their Clinical and Angiographic Associations, and Prognostic Relevance - A Cohort Study.

Abstract

Objectives: We analysed interventions related to TAK, their pre-treatment clinical and angiographic associations, and prognostic relevance from a large ambispective, monocentric cohort of TAK from India.

Methods: Information regarding endovascular or open surgical interventions (aortoplasty, nephrectomy for refractory hypertension) was retrieved from a cohort of patients with TAK. Demographic characteristics, clinical features, and angiographic involvement were compared between patients with TAK who had undergone interventions with the rest of the cohort using multivariable-adjusted odds ratios (OR, with 95% CI). Hazard ratios were used to compare the mortality rate among TAK who had undergone interventions.

Results: Among 238 patients with TAK in the cohort, 41(17.23%) had undergone 69 interventions related to TAK (64 endovascular procedures, one open surgical aortoplasty, 4 nephrectomies) across 55 sittings (a single intervention sitting in 31, two in seven, three in two, and four in one). The most common arterial territories undergoing intervention were the renal arteries (n=21), subclavian arteries (n=8), and descending thoracic aorta (n=6). Six patients with TAK required repeated interventions in the same arterial territories. Patients with TAK who underwent interventions more frequently had abdominal angina (OR 5.12, 95%CI 1.36-19.26), and less often had constitutional features (OR 0.39, 0.18-0.84) at presentation without significant differences in angiography. Survival was similar in TAK who had undergone interventions to those without (hazard ratio for mortality 0.91, 95%CI 0.23-3.55).

Conclusion: About one-sixth of our cohort of TAK had undergone interventions, most often endovascular interventions. One-fourth required multiple interventions. Survival was similar in TAK with or without interventions.