CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
e6
AFRICA
lar involvement can be single or concurrent. Disconnection,
disintegration and perivascular inflammatory cell infiltration of
the medial elastic fibres and degeneration in the vasa vasorum
have been observed on microscopic examination.
6
In one study,
pseudo-aneurysms were common in large or medium-sized
arteries, whereas obstructions and stenoses were common in the
distal run-off arteries of the lower extremities. Different luminal
diameters of the involved arteries accounted for the frequent
involvement of the distal run-off arteries.
The stage of active vasculitis of BD is pathologically char-
acterised by massive infiltration of acute inflammatory cells,
particularly involving layers of the media and adventitia. At
this stage, the intima is swollen and the lumen is commonly
thrombosed. Obstructions and stenoses therefore usually occur
in the smaller arteries. If there is no thrombosis in the vessel
and there is advanced vasculitis, severe inflammation makes the
arterial wall weak and sets the stage for the formation of pseudo-
aneurysm.
7
Vascular involvement can be observed in up to 40% of
patients, and venous disease is more frequent than arterial
disease.
5
Venous occlusions, superficial venous thrombosis,
deep-vein thrombosis, vena cava thrombosis, cerebral venous
thrombosis, Budd-Chiari syndrome, portal vein thrombosis and
varices can be seen related to the venous system.
8
Arterial involvement occurs in only one to 7% of patients
with Behcet’s syndrome. Aneurysms, stenoses and obstruc-
tions comprise the arterial complications. The most frequently
affected artery is the aorta, followed by the pulmonary, femoral,
subclavian, popliteal, brachial, iliac and common carotid arter-
ies, with decreasing frequency.
5,9
Iliac artery aneurysm is seen at
a rate of only 0.6%.
10
It is very important to identify patients with vasculo-Behçet,
because they are at risk of developing recurrent vascular lesions
after the first episode of vascular injury, and are predisposed to
progressive multifocal vessel-related complications.
8,9
Therefore,
their prognosis is worse
2
and they may need more aggressive
treatment.
8
Men and patients whose disease started at a younger
age are at a higher risk for vascular involvement.
9
Male patients
are much more likely to be affected with arterial disease,
compared to females. Smoking may be a risk factor for arterial
disease in patients with BD.
8
Due to weakness and fragility of the
vessel wall and arteritis, open surgical intervention may result in
complications, such as the development of pseudo-aneurysms
and thrombosis at the sites of anastomosis.
11
Surgical intervention frequently results in complications, such
as recurrent pseudo-aneurysms, graft occlusions, or the develop-
ment of new aneurysms at the anastomotic or other sites, because
of further damage to the vulnerable vessel wall.
5
Development
of aneurysm ranges from one to 12 months postoperatively.
Pseudo-aneurysm is the development of a pulsatile haema-
toma as a result of rupture of the whole vessel wall. Aneurysms
have the risk of rupture and infection. Aneurysm formation is
observed in these patients, even at the insertion sites of venous
lines placed for imaging methods.
12
Surgery is generally indicated for the treatment of systemic
arterial aneurysms, as there is a risk of rupture.
8
On the other
hand, due to the weakness and fragility of the vessel wall and
arteritis, open surgery has complications, such as the develop-
ment of pseudo-aneurysms and thrombosis at the anastomotic
sites.
11
We therefore did not consider a surgical approach for
the present patient, and there was a risk of aneurysm during
percutaneous implantation of a stent into the iliac artery. During
the three-year follow up of the patient, however, no aneurysm or
stent occlusion was observed.
When there are no symptoms, non-operative treatment is
elected for obstructive or stenotic lesions. However, cortico-
steroids, immunosuppressives or surgical intervention may be
appropriate.
Initial success rates of selective stent placement for iliac
artery stenosis are 97 to 99%, and the three-year patency rates
range from 74 to 86%. Stents have improved the initial rate of
endovascular treatment of iliac artery occlusions. The rate of
early stent occlusion was reported to be 1% in patients who
had stents for iliac artery stenosis.
13
The patency rates for three
and 10 years after balloon dilatation for intrastent stenosis were
64–85% and 46%, respectively.
14
Balloon dilatation is also
thought to enhance long-term treatment outcomes.
Occlusion of arteries is less common in BD and stent implan-
tation is a good choice of treatment in these patients as the risk
of aneurysm is high after surgical intervention.
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