Endovascular treatment of aortic pseudoaneurysm in Behçet disease

Objective

This study evaluated the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppressive therapy for aortic pseudoaneurysms in patients with Behçet disease.

Methods

Between April 2002 and April 2008, 12 pseudoaneurysms (9 involving the intrarenal abdominal aorta, 1 at the suprarenal level, and 2 in the supraceliac aorta) in nine men and one woman with Behçet disease were evaluated at Peking Union Medical Center (PUMC). Three bifurcated stent grafts and seven tubular stent grafts, including two fenestrated stent grafts, were deployed. All 10 patients received immunosuppressive therapy after the implant procedure.

Results

All patients underwent successful endovascular therapy without major complications during the 30 days immediately after the procedure. One patient with two aneurysms had treatment of only the larger infrarenal symptomatic aneurysm, but the smaller suprarenal pseudoaneurysm was not addressed because of its proximity to mesenteric branches. During a mean follow-up of 25.8 months (range, 6-50 months), nine aneurysms resolved completely in eight patients. The only untreated aneurysm, which coexisted with a treated lesion, remained stable under imaging observation. Three aneurysms recurred in two patients. At 6 months, one patient presented with a new aneurysm at the femoral artery access site for stent graft introduction and another formed at the proximal margin of the stent graft. Despite medical advice, he had stopped immunotherapy. He died from aneurysm rupture 8 months after stent deployment. Another patient with recurrent aneurysmal disease at the distal margin of the primary stent was successfully treated with an additional stent graft. These two were the only patients who did not adhere to taking immunosuppressant medicine after discharge.

Conclusion

Endovascular stent graft placement combined with immunosuppressive treatment for aortic pseudoaneurysms in Behçet disease is a feasible and effective management option. Long-term immunosuppressive therapy after endovascular repair is important to limit pseudoaneurysm recurrence.