VENA CAVAL SYNDROMES IN BEHÇET DISEASE Diagnostic and therapeutic modalities


AKÇALI Y. F.

18th World Society of Cardio-Thoracic Surgeons 2008 World Congress, Greece, 1 - 04 May 2008, pp.50

  • Publication Type: Conference Paper / Summary Text
  • Country: Greece
  • Page Numbers: pp.50
  • Erciyes University Affiliated: Yes

Abstract

BACKGROUND. Behçet disease (BD) is a heterogenous, multisystem, inflammatory disorder; vascular involvement, which mainly affects veins, occurs in 25-50 % of the patients, whereas caval involvement is rare. We present the patients with BD, which affects vena cavae, resulting in vascular syndromes. METHODS. In our department, 14 patients, one of them was a female, with BD resulting in caval occlusion were followed-up and treated in last 1.5 decade. The patients’ median age was 31 years (range, 18 to 60 years). These patients accounted for one-fourth of the patients with vasculo-Behçet disease managed during the same period. Our cases with caval thrombosis reported previously excluded from this study [1]. The patients were either following with diagnosis of BD or had been admitted initially to hospital with symptoms and signs of venous disease. Diagnosis of BD was verified by duplex ultrasound, MRA, CTA and or contrast angiography. Inferior vena caval involvement often associated with chronic venous insufficiency affecting bilateral lower limbs. In addition, the rate of concomitancy between systemic or pulmonic arterial aneurysms and caval occlusions was important (42.8%). RESULTS. Two cases with superior vena caval syndrome were treated by jugulo-atrial bypass grafting (Figure 1&2). One patient who had multi-organ failure was exitus. CONCLUSIONS. Surgical management with long-term results is an effective therapeutic modality. Although spiral saphenous vein graft remains the conduit of choice for surgical reconstruction, its obtaining is always not possible, and therefore expanded externally supported polytetrafluoroethylene is a good alternative. Although endovascular treatment for superior vena caval obstructions of other nonmalignant etiology is effective in the short term, with frequent need for repeat interventions, it is not always possible in Behçet disease. [1]Y.Akcali, et al. Venous lesions in vasculo-Behçet’s syndrome. Erciyes Medical Journal; 13:412-415, 1991.