The Asia Pacific meeting for vasculitis and ANCA workshop 2012: surgical treatment for Takayasu's arteritis.

Surgical interventions are performed to ameliorate the complications of Takayasu's arteritis, which adversely affects life expectancy. However, the efficacy of surgery in relation to long-term survival of the patients remains to be evaluated. A retrospective review was performed on 110 consecutive patients with Takayasu's arteritis who underwent surgical treatment at our single institution. Survival was compared with the reported results of medically treated patients according to Ishikawa's prognostic classification. There were 12 hospital deaths, and the remaining 98 patients were followed up from 10 months to 48.4 years (mean 21.6 years). A serious long-term complication was anastomotic aneurysms with a cumulative incidence at 10 and 20 years of 7.8 and 14.8 %, respectively. Thirty-seven late deaths were observed and the major causes were congestive heart failure and anastomotic aneurysms. The cumulative survival rate at 10 and 20 years was 84.3 and 70.4 %, respectively. In patients classified as stage 3 by Ishikawa, surgery seemed to increase survival; however, surgery-associated complications conversely decreased the survival of patients with stage 1 disease. Surgery seems to increase the long-term survival of patients with stage 3 Takayasu's arteritis by Ishikawa's prognostic classification. Conservative treatment is recommended for those with stage 1 or 2 disease. Anastomotic aneurysms may occur at any time after surgery, and regular follow-up is mandatory for the rest of the patient's life. This article was based on previous reports by the author with several additional patients and follow-up periods.