Endovascular therapy combined with immunosuppressive treatment for pseudoaneurysms in patients with behçet's disease

Purpose: To evaluate the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppression for the treatment of arterial pseudoaneurysms due to Behçet's disease. Methods: Eleven pseudoaneurysms (3 in the abdominal aorta, 3 in the subclavian artery, and individual lesions in the brachiocephalic artery, renal artery, common iliac artery, common carotid artery, and the descending thoracic aorta) in 9 patients with Behçet's disease were treated with 10 stent-grafts and 1 self-expanding stent. All patients with elevated erythrocyte sedimentation rate (ESR) were treated with immunosuppressive agents (azathioprine, prednisolone) before and after the procedure. Results: Endovascular treatment was successful in all cases, without major adverse events. The ESR was reduced from 42.7±18.0 mm/h initially to 18.6±12.6 mm/h after immunosuppressive therapy prior to endovascular repair. During follow-up (mean 24.1±14.0 months, range 6-43), 8 of 11 lesions showed complete resolution. One stent-graft to treat a postsurgical recurrent carotid artery pseudoaneurysm was occluded, and an abdominal aortic pseudoaneurysm recurred; both patients stopped their medications. ESR during follow-up was 7.9±4.5 mm/h. Conclusions: Endovascular treatment for pseudoaneurysms due to Behçet's disease is feasible and effective when disease activity is strictly controlled with immunosuppressive therapy.