Naciye Sinem GEZER, Aytaç GÜLCÜ, Erdem Erinç SİLİSTRELİ

Vasküler Behçet hastalığında endovasküler stent greft onarımı sonrasında gelişen tekrarlayan aort anevrizmaları

Endovasküler stent greft tedavisi vasküler Behçet has- talığında cerrahi onarım sonrasında sıklıkla anasto- moz düzeylerinde gelişen tekrarlayıcı anevrizmaların önlenmesinde kullanılan bir tedavi yöntemidir. Stent greft distal ve proksimal tutunma bölgelerinde de psö- doanevrizmalar gelişebilir. Bu yazıda, etkisiz immün- süpresyonun stent greftin proksimal ve distal uçlarında ve çevresinde tekrarlayan psödoanevrizma gelişimine neden olduğu vasküler Behçet hastalığı olan, 38 yaşın- da bir erkek olgu sunuldu. Vasküler Behçet hastalarında endovasküler stent-greft tedavisi cerrahiye alterna- tif olarak düşünülebilmekle birlikte, nispeten düşük, ancak devam eden tekrarlayan psödoanevrizma riski halen mevcuttur.

Recurrent aneursyms following endovascular stent-grafting repair in vascular Behçet's disease

Endovascular stent-graft treatment is one of the treatment modalities in prevention of recurrent aneurysms at the anastomosis site which are common following surgical repair of aneurysms in vascular Behçet's disease. Pseudoaneurysms may also develop at the distal and proximal landing zones of the stent-graft. In this article, we report a 38-year-old male case of vascular Behçet's disease in whom ineffective immunosuppression resulted in the development of recurrent pseudoaneurysms at the proximal and distal ends of the stent graft and all around it. Although stent graft placement may be considered as an alternative treatment to surgery in patients with vascular Behçet's disease, a relatively low, but ongoing risk of recurrent pseudoaneurysm still remains.

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1. Tohmé A, Aoun N, El-Rassi B, Ghayad E. Vascular manifestations of Behçet's disease. Eighteen cases among 140 patients. Joint Bone Spine 2003;70:384-9.
2. Kwon TW, Park SJ, Kim HK, Yoon HK, Kim GE, Yu B. Surgical treatment result of abdominal aortic aneurysm in Behçet's disease. Eur J Vasc Endovasc Surg 2008;35:173-80.
3. Tüzün H, Beşirli K, Sayin A, Vural FS, Hamuryudan V, Hizli N, et al. Management of aneurysms in Behçet's syndrome: an analysis of 24 patients. Surgery 1997;121:150-6.
4. Vasseur MA, Haulon S, Beregi JP, Le Tourneau T, Prat A, Warembourgh H. Endovascular treatment of abdominal aneurysmal aortitis in Behçet's disease. J Vasc Surg 1998;27:974-6.
5. Park JH, Chung JW, Joh JH, Song SY, Shin SJ, Chung KS, et al. Aortic and arterial aneurysms in behçet disease: management with stent-grafts--initial experience. Radiology 2001;220:745-50.
6. Bonnotte B, Krause D, Fanton AL, Theron J, Chauffert B, Lorcerie B. False aneurysm of the internal carotid artery in Behçet's disease: successful combined endovascular treatment with stent and coils. Rheumatology (Oxford) 1999;38:576-7.
7. 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.
8. Sener E, Bayazit M, Göl MK, Mavitas B, Tasdemir O, Bayazit K. Surgical approach to pseudoaneurysms with Behçet's disease. Thorac Cardiovasc Surg 1992;40:297-9.
9. Sasaki Sh, Yasuda K, Takigami K, Shiiya N, Matsui Y, Sakuma M. Surgical experiences with peripheral arterial aneurysms due to vasculo-Behçet's disease. J Cardiovasc Surg (Torino) 1998;39:147-50.
10. Ozguc H, Topal NB, Topal E. Secondary aortoenteric fistula in a patient with Behçet disease: successful surgical treatment by direct suture and use of omental flap. Vascular 2008;16:300-2.
11. Nitecki SS, Ofer A, Karram T, Schwartz H, Engel A, Hoffman A. Abdominal aortic aneurysm in Behçet's disease: new treatment options for an old and challenging problem. Isr Med Assoc J 2004;6:152-5.
12. Ishikawa S, Kawasaki A, Suzuki Y, Neya K, Wada S, Kugawa S, et al. Progression of abdominal aortic aneurysm after endovascular stent-grafting in a patient with Behçet's disease: report of a case. Surg Today 2007;37:82-5.
13. Kwon Koo B, Shim WH, Yoon YS, Kwon Lee B, Choi D, Jang Y, et al. Endovascular therapy combined with immunosuppressive treatment for pseudoaneurysms in patients with Behçet's disease. J Endovasc Ther 2003;10:75-80.
14. Erpenbach S, Arlart IP, Tremmel-Lehnert C, Hupp T. Abdominal aortic aneurysm in Behçet's disease: treatment with endovascular stent graft. Eur Radiol 2001;11:2539-42.
15. Kalko Y, Basaran M, Aydin U, Kafa U, Basaranoglu G, Yasar T. The surgical treatment of arterial aneurysms in Behçet disease: a report of 16 patients. J Vasc Surg 2005;42:673-7. CT visualises inflammatory activity of pulmonary artery aneurysms in Behçet disease. Eur J Nucl Med Mol Imaging 2007;34:970.
17. Kim WH, Choi D, Kim JS, Ko YG, Jang Y, Shim WH. Effectiveness and safety of endovascular aneurysm treatment in patients with vasculo-Behçet disease. J Endovasc Ther 2009;16:631-6