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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Endarterectomy | Research

Pulmonary endarterectomy in patients with occlusive isolated pulmonary vasculitis

Authors: Jiexu Ma, Wu Song, Hang Xu, ZhaoJi Zhong, Yige Huyan, Sheng Liu

Published in: European Journal of Medical Research | Issue 1/2023

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Abstract

Background

Isolated pulmonary vasculitis (IPV) is a rare, insidious, and localized inflammatory disease affecting the pulmonary arteries, often leading to severe luminal obstruction. The prognosis for patients with occlusive IPV is poor, and there is currently a lack of effective treatments. The objective of this study was to evaluate the performance of pulmonary endarterectomy (PEA) as a treatment for occlusive IPV.

Methods

This single-center retrospective analysis included patients who received PEA for occlusive IPV between January 2018 and June 2022. Clinical characteristics and hemodynamic parameters were evaluated at baseline and follow-up.

Results

Among 114 consecutive patients who underwent PEA, occlusive IPV was identified in 7 patients. Two patients underwent bilateral PEA for the involvement of both pulmonary arteries. Patch angioplasty was performed to treat four severe constrictions. One patient died from residual pulmonary hypertension after limited PEA of a transmural vascular lesion. In addition, no obvious surgical complications were observed. Three months after PEA, a substantial relief in symptoms was achieved. Also, there is a decrease in the mean pulmonary artery pressure (median 33 [20–48] mmHg before versus median 21 [16–26] mmHg after; P < 0.018) and pulmonary arterial resistance (median 234 [131–843] dyn.s.cm−5 versus median 180 [150–372] dyn.s.cm−5; P = 0.310). Three patients experienced a relapse of restenosis of the treated arteries within a 6-month follow-up period, despite daily oral prednisolone administration. They were treated with balloon pulmonary angioplasty of both the main pulmonary arteries and branches.

Conclusions

PEA is a valuable choice for treating occlusive IPV, with notable hemodynamic and clinical advantages. To increase long-term vascular patency, complete management should be optimized.
Literature
1.
2.
Yanartaş M, Karakoç AZ, Zengin A, Taş S, Yildizeli ŞO, Mutlu B, et al. Multimodal approach of isolated pulmonary vasculitis: a single-institution experience. Ann Thorac Surg. 2022;114(4):1253–61.CrossRefPubMed
3.
Xia H, Jiang Y, Cai Y, Tang J, Gao Y, Sun J. Isolated pulmonary vasculitis. Circulation. 2015;132(20):e235–8.CrossRefPubMed
4.
Hagan G, Gopalan D, Church C, Rassl D, Mukhtyar C, Wistow T, et al. Isolated large vessel pulmonary vasculitis as a cause of chronic obstruction of the pulmonary arteries. Pulm Circ. 2011;1:425–9.CrossRefPubMedPubMedCentral
5.
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618–731.CrossRefPubMed
6.
7.
Brister SJ, Wilson-Yang K, Lobo FV, Yang H, Skala R. Pulmonary thrombo-endarterectomy a patient with giant cell arteritis. Ann Thorac Surg. 2002;73(6):1977–9.CrossRefPubMed
8.
9.
Moser KM, Braunwald NS. Successful surgical intervention in severe chronic thromboembolic pulmonary hypertension. Chest. 1973;64:29–35.CrossRefPubMed
10.
Song W, Zhu J, Zhong Z, Song Y, Liu S. Long-term outcome prediction for chronic thromboembolic pulmonary hypertension after pulmonary endarterectomy. Clin Cardiol. 2022;45(12):1255–63.CrossRefPubMedPubMedCentral
11.
Mahmud E, Madani MM, Kim NH, Poch D, Ang L, Behnamfar O, et al. Chronic thromboembolic pulmonary hypertension: evolving therapeutic approaches for operable and inoperable disease. J Am Coll Cardiol. 2018;71:2468–86.CrossRefPubMed
12.
Yan S, Lou S, Zhu J, Liu S, Zhao Y, Song Y, et al. Perfusion strategy and mid-term results of 58 consecutive pulmonary endarterectomy. Perfusion. 2019;34:475–81.CrossRefPubMed
13.
14.
Skoro-Sajer N, Marta G, Gerges C, Hlavin G, Nierlich P, Taghavi S, et al. Surgical specimens, haemodynamics and long-term outcomes after pulmonary endarterectomy. Thorax. 2014;69(2):116–22.CrossRefPubMed
15.
Miyahara S, Schröder TA, Wilkens H, Karliova I, Langer F, Kunihara T, et al. Long-term outcomes after pulmonary endarterectomy in 499 patients over a 20-year period. Ann Thorac Surg. 2021;111(5):1585–92.CrossRefPubMed
16.
Kerr KM, Elliott CG, Chin K, Benza RL, Channick RN, Davis RD, et al. Results from the United States chronic thromboembolic pulmonary hypertension registry: enrollment characteristics and 1-year follow-up. Chest. 2021;160(5):1822–31.CrossRefPubMedPubMedCentral
17.
Adams TN, Zhang D, Batra K, Fitzgerald JE. Pulmonary manifestations of large, medium, and variable vessel vasculitis. Respir Med. 2018;145:182–91.CrossRefPubMed
18.
Gerges C, Friewald R, Gerges M, Shafran I, Sadushi-Koliçi R, Skoro-Sajer N, et al. Efficacy and safety of percutaneous pulmonary artery subtotal occlusion and chronic total occlusion intervention in chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2021;14(8):e010243.CrossRefPubMed
19.
Zhou YP, Wei YP, Yang YJ, Xu XQ, Wu T, Liu C, et al. Percutaneous pulmonary angioplasty for patients with takayasu arteritis and pulmonary hypertension. J Am Coll Cardiol. 2022;79(15):1477–88.CrossRefPubMed
20.
Tajti P, Alaswad K, Karmpaliotis D, Jaffer FA, Yeh RW, Patel M, et al. Procedural outcomes of percutaneous coronary interventions for chronic total occlusions via the radial approach: insights from an international chronic total occlusion registry. JACC Cardiovasc Interv. 2019;12(4):346–58.CrossRefPubMed
21.
Sugawara M, Suzuki C, Kanda M, Takahashi H. Insidious pulmonary artery stenosis in Takayasu arteritis. QJM. 2022;115(6):399.CrossRefPubMed
22.
Seitz L, Seitz P, Pop R, Lötscher F. Spectrum of large and medium vessel vasculitis in adults: primary vasculitides, arthritides, connective tissue, and fibroinflammatory diseases. Curr Rheumatol Rep. 2022;24(11):352–70.CrossRefPubMedPubMedCentral
23.
Perera AH, Youngstein T, Gibbs RGJ, Jackson JE, Wolfe JH, Mason JC. Optimizing the outcome of vascular intervention for Takayasu arteritis. Br J Surg. 2014;101(2):43–50.CrossRefPubMed
24.
Maz M, Chung SA, Abril A, Langford CA, Gorelik M, Guyatt G, et al. American college of rheumatology/vasculitis foundation guideline for the management of giant cell arteritis and takayasu arteritis. Arthritis Rheumatol. 2021;73(8):1349–65.CrossRefPubMed
25.
Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020;79(1):19–30.CrossRefPubMed
26.
Barra L, Yang G, Pagnoux C. Non-glucocorticoid drugs for the treatment of Takayasu’s arteritis: a systematic review and meta-analysis. Autoimmun Rev. 2018;17(7):683–93.CrossRefPubMed
27.
Nakaoka Y, Isobe M, Takei S, Tanaka Y, Ishii T, Yokota S, et al. Efficacy and safety of tocilizumab in patients with refractory Takayasu arteritis: results from a randomised, double-blind, placebo-controlled, phase 3 trial in Japan (the TAKT study). Ann Rheum Dis. 2018;77(3):348–54.CrossRefPubMed
28.
Riancho-Zarrabeitia L, Zurbano F, Gómez-Román J, Martínez-Meñaca A, López M, Hernández MA, et al. Isolated pulmonary vasculitis: case report and literature review. Semin Arthritis Rheum. 2015;44(5):514–7.CrossRefPubMed
29.
Fujita K, Nakashima K, Kanai H, Kumakura H, Minami K. A successful surgical repair of pulmonary stenosis caused by isolated pulmonary Takayasu’s arteritis. Heart Vessels. 2013;28:264–7.CrossRefPubMed
30.
Jiang X, Zhu YJ, Zhou YP, Peng FH, Wang L, Ma W, et al. Clinical features and survival in Takayasu’s arteritis-associated pulmonary hypertension: a nationwide study. Eur Heart J. 2021;42(42):4298–305.CrossRefPubMed
31.
Bhasin S, Gogia P, Nair R, Sahoo TK. Perioperative sildenafil therapy for children with ventricular septal defects and associated pulmonary hypertension undergoing corrective surgery: a randomised clinical trial. Indian J Anaesth. 2017;61(10):798–802.CrossRefPubMedPubMedCentral
Metadata
Title
Pulmonary endarterectomy in patients with occlusive isolated pulmonary vasculitis
Authors
Jiexu Ma
Wu Song
Hang Xu
ZhaoJi Zhong
Yige Huyan
Sheng Liu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01239-8

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