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      Un aneurisma de aorta abdominal roto revela una enfermedad de Behçet Translated title: Ruptured abdominal aortic aneurysm reveals Behçet's disease

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          Abstract

          Resumen Introducción: la enfermedad de Behçet es una vasculitis sistémica de etiología desconocida que afecta generalmente a adultos jóvenes y que puede producir manifestaciones sistémicas (oftálmicas, neurológicas, cardíacas, pulmonares, vasculares y renales) que con frecuencia son la causa final de muerte de estos pacientes. Caso clínico: presentamos el caso clínico de un paciente varón de 56 años con criterios clínicos para el diagnóstico de la enfermedad de Behçet (lesión oral y ulceración genital recurrente) que presentó la rotura de un aneurisma de aorta abdominal. El tratamiento quirúrgico fue mediante resección del aneurisma y reparación de la aorta asociado a terapia inmunosupresora. El posoperatorio cursó con buena evolución. Discusión: la enfermedad de Behçet se asocia con frecuencia a manifestaciones vasculares a diferentes niveles, por lo que el tratamiento debe individualizarse.

          Translated abstract

          Abstract Background: Behçet´s disease is a systemic vasculitis of unknown etiology, which generally affects young adults and can produce systemic manifestations (ophthalmic, neurological, cardiac, pulmonary, vascular and renal), which are often the final cause of death in these patients. Case report: we present the clinical case of a 56-year-old male patient with clinical criteria for the diagnosis of Behçet's disease (oral lesion and recurrent genital ulceration) who presented a ruptured abdominal aortic aneurysm. Surgical treatment was by resection of the aneurysm and repair of the aorta associated with immunosuppressive therapy. The postoperative period evolved satisfactorily. Disussion: Behçet´s disease is frequently associated with vascular manifestations at different levels, so treatment must be individualized.

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          Criteria for diagnosis of Behcet's disease

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            Emergency endovascular repair for ruptured abdominal aortic aneurysms: feasibility and comparison of early results with conventional open repair.

            To assess the feasibility of endovascular aortic repair (EVAR) on patients presenting with a ruptured abdominal aortic aneurysm (AAA) in a teaching hospital, and to compare there post-operative outcomes with contemporaneous patients treated with open repair (OR). A series of consecutive of patients presenting ruptured AAA with retro/intraperitoneal haematoma were included in the study. EVAR was attempted whenever possible. In all other cases (severe haemodynamic instability, adverse anatomy, device unavailability), ruptured AAA were treated by OR. Thirty-seven patients were enrolled between January 2001 and July 2004. Seventeen (46%) patients were treated using adapted designed aortoiliac endografts (eight bifurcated, eight aorto-uniiliac, one iliac extension). Twenty (54%) patients unfit for EVAR because of severe haemodynamic instability (n=8), adverse anatomical configuration (n=7), or unavailability of an appropriate endograft (n=5) were treated by OR. Twenty-seven (73%) had a retrospective suitable anatomy for EVAR. Three early conversions from EVAR to OR were performed. Blood loss, operating time, and intensive care stay were significantly decreased in EVAR patients (respectively: 156 min+/-60, 1520 ml+/-1175, 3 days for EVAR; vs. 222 min+/-82, 3075 ml+/-1750, 13 days for OS; P<.01). The 30-day mortality rate was 23.5% for EVAR vs. 50% for OR (P=0.09). EVAR of ruptured AAA is feasible for selected patients based on haemodynamic and morphologic criteria, and should be associated with improved immediate outcomes as compared with OR. These results should be tempered by the fact that these patients have heavy comorbidities which explains the absence of difference in mid-term mortality rates between the two groups, but should also encourage surgical institutions that are managing such life-threatening emergencies to introduce EVAR as part of their therapeutic arsenal for ruptured AAA.
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              Surgical outcomes and risk factors for postoperative complications in patients with Behcet's disease.

              This study aims to investigate surgical outcomes in patients with Behcet's disease (BD) and to identify risk factors for the occurrence of postoperative complications. The medical records of 37 patients with newly diagnosed BD were reviewed retrospectively. All patients fulfilled the International Study Group criteria for diagnosis of BD and underwent surgeries after diagnosis. Demographic, clinical, and laboratory data at the time when surgeries were performed were collected and surgical modalities, postoperative complications, and postoperative medical treatments were evaluated. Forty-three surgeries were performed in 37 patients. During mean follow-up duration of 78.2 +/- 50.3 months, 14 surgeries (32.6%) were complicated by wound dehiscence, infection, and graft occlusion or failure with the mean lag time of 6.0 +/- 4.6 months from surgeries. Cumulative incidence of postoperative complications was 7.7% at 3 months, 25.6% at 6 months, 33.3% at 12 months, and 35.9% at 18 months. Postoperative complications occurred more frequently after surgeries that were performed in patients with positive pathergy test (P < 0.001) and after vascular surgeries than after nonvascular surgeries (P < 0.05). Moreover, surgeries that were followed by glucocorticoids with immunosuppressive agents showed a significantly lower postoperative complication rate compared to those that were followed by glucocorticoids alone and those that were not followed by medical treatment (P < 0.05). Multivariate analysis showed that a positive pathergic reaction (P < 0.05, hazard ratio = 1.91) at the time of surgery and surgeries that were not followed by treatment with glucocorticoids and immunosuppressive agent (P < 0.01, hazard ratio = 2.11) was an independent risk factor for the occurrence of postoperative complications. Our findings suggest that the occurrence of postoperative complications can be reduced when postsurgical immunosuppressive treatment was implemented and that the pathergy test can be used as screening methods for occurrence of postoperative complications in patients with BD.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                October 2022
                : 74
                : 5
                : 249-252
                Affiliations
                [2] Tánger orgnameUniversidad Abdelmalek Essaadi orgdiv1Facultad de Medicina y Farmacia de Tánger Marruecos
                [3] Tánger orgnameCentro Hospitalario Universitario de Tánger orgdiv1Servicio de Radiología Marruecos
                [1] Tánger orgnameCentro Hospitalario Universitario de Tánger orgdiv1Cirugía Vascular y Endovascular orgdiv2Servicio de Angiología Marruecos
                Article
                S0003-31702022000500007 S0003-3170(22)07400500007
                10.20960/angiologia.00385
                bc973961-6182-4cd2-b449-344adbfd521a

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 05 July 2022
                : 25 December 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 4
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Enfermedad de Behçet,Rotura,Aneurisma de aorta abdominal,Rupture,Abdominal aortic aneurysm,Behçet's disease

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