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Ann Thorac Surg 2009;87:1649. doi:10.1016/j.athoracsur.2008.12.012
© 2009 The Society of Thoracic Surgeons
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Correspondence

Behçet's Inflammatory Vessels for Cannulation in Inflammatory Aortic Repair

Ahmet Akgul, MD

Turkiye Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, 06100 Turkey

(Email: aakgul{at}turkiyeklinikleri.com).

To the Editor:

I read the excellent study of Pacini and colleagues [1] with great interest. They stated that surgery for inflammatory aortopathy is associated with high morbidity and mortality (23.1% vs 10% in their experience) when compared with inflammatory and noninflammatory patients. They pointed out that a systemic inflammatory process that affects all vessels is a major reason for higher morbidity and mortality.

Inflammation is one of the pathologic hallmarks of Behçet's disease, which affects vessels of all sizes, known as "vasculo-Behçet" [2]. One of the major manifestations of vasculo-Behçet is arterial aneurysm formation, which occured in only 1 patient in Pacini and colleagues' [1] series. Pacini and coworkers [1] performed antegrade selective cerebral perfusion and aortic repair. The upper right brachial artery [3] and left subclavian artery [4] are used for cannulation in patients for aortic arch repair in our clinic. The cannulation vessel is important, because cannulation would be a serious problem for the choice of patients with multi-vessel inflammatory diseases.

Omitting surgery may avoid acute exacerbation of inflammatory aortopathy and avoid formation of new aneurysms at the site of the suture line. The authors should explain why new aneurysm formation was fewer than expected, because immunosupresive therapy was not used. Was other antiinflammatory therapy used during follow-up? If so, why was the mortality higher than their overall rate for thoracic aortic repair?

Pacini and coworkers [1] recommend that preoperative measurement of C-reactive protein and erythrocyte sedimentation rate for all patients undergoing aortic surgery. Erythrocyte sedimentation rate and C-reactive protein may not add information because Zouboulis and coworkers [5] found high serum levels of interleukin-8 in patients with active Behçet's disease with vascular involvement. Endotelial cells could be responsible for secretion of interleukin-8 during the active phase; thus monitoring erythrocyte sedimentation rate and C-reactive protein might not be reliable without interleukin-8, especially in patients with Behçet's disease.


   References
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 References
 

  1. Pacini D, Leone O, Turci S, et al. Incidence, etiology, histologic findings, and course of thoracic inflammatory aortopathies Ann Thorac Surg 2008;86:1518-1523.[Abstract/Free Full Text]
  2. Akgul A. Hormonal changes in vasculo-Behçet's disease Turkiye Klinikleri J Med Sci 2008;28:599-600.
  3. Akgul A, Ozatik MA, Kucuker SA, Bahar I, Tasdemir O. Repair of aortic arch with left unilateral selective cerebral perfusion Perfusion 2004;19:77-79.[Abstract/Free Full Text]
  4. Tasdemir O, Saritas A, Kucuker S, Ozatik MA, Sener E. Aortic arch repair with right brachial artery perfusion Ann Thorac Surg 2002;73:1837-1842.[Abstract/Free Full Text]
  5. Zoubolis CC, Katsantonis J, Ketteler R, et al. Adamantides-Behçet's disease: interleukin-8 is increased in serum of patients with active oral and neurological manifestations and is secreted by small vessel endotelial cells Arch Dermatol Res 2000;292:279-284.[Medline]

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Davide Pacini, Ornella Leone, Simone Turci, and Roberto Di Bartolomeo
Ann. Thorac. Surg. 2009 87: 1649-1650. [Extract] [Full Text] [PDF]



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D. Pacini, O. Leone, S. Turci, and R. Di Bartolomeo
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Ann. Thorac. Surg., May 1, 2009; 87(5): 1649 - 1650.
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