DOI QR코드

DOI QR Code

Characterization of Venous Involvement in Vasculo-Behçet Disease

  • Lee, Na Hyeon (Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Bae, Miju (Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jin, Moran (Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Chung, Sung Woon (Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Lee, Chung Won (Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jeon, Chang Ho (Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2020.04.21
  • Accepted : 2020.09.19
  • Published : 2020.12.05

Abstract

Background: Behçet disease is a chronic inflammatory disorder with a varying etiology. Herein, we report the involvement of peripheral veins in Behçet disease and discuss the treatment thereof. Methods: Thirty-four patients with venous involvement in vasculo-Behçet disease were retrospectively analyzed over 15 years. We reviewed the clinical manifestations, treatment choices, and complications of these patients. Results: Deep vein thrombosis (DVT) was observed in 24 patients (70.59%) and varicose veins in 19 (52.94%). Immunosuppressive treatment was administered to all patients due to the pathological feature of vein wall inflammation. In patients with DVT, anticoagulation therapy was also used, but post-thrombotic syndrome was observed in all patients along with chronic luminal changes. Eleven patients with isolated varicose veins underwent surgery; although symptoms and lesions recurred in half of these patients, no cases of secondary DVT occurred. Conclusion: When DVT was diagnosed in patients with Behçet disease, there was no cure for the lesions. Ultrasonographic abnormalities were observed in all patients, and post-thrombotic syndrome remained to varying degrees. In cases of isolated varicose veins in patients with Behçet disease, DVT did not occur after surgical treatment. If the activity of Behçet disease is controlled, surgical correction of varicose veins is preferable.

Keywords

References

  1. Sakane T, Takeno M, Suzuki N, Inaba G. Behcet's disease. N Engl J Med 1999;341:1284-91. https://doi.org/10.1056/NEJM199910213411707
  2. Davatchi F, Chams-Davatchi C, Shams H, et al. Behcet's disease: epidemiology, clinical manifestations, and diagnosis. Expert Rev Clin Immunol 2017;13:57-65. https://doi.org/10.1080/1744666X.2016.1205486
  3. Koc Y, Gullu I, Akpek G, et al. Vascular involvement in Behcet's disease. J Rheumatol 1992;19:402-10.
  4. Houman MH, Neffati H, Braham A, et al. Behcet's disease in Tunisia: demographic, clinical and genetic aspects in 260 patients. Clin Exp Rheumatol 2007;25(4 Suppl 45):S58-64.
  5. Duzgun N, Ates A, Aydintug OT, Demir O, Olmez U. Characteristics of vascular involvement in Behcet's disease. Scand J Rheumatol 2006;35:65-8. https://doi.org/10.1080/03009740500255761
  6. Kim JN, Kwak SG, Choe JY, Kim SK. The prevalence of Behcet's disease in Korea: data from Health Insurance Review and Assessment Service from 2011 to 2015. Clin Exp Rheumatol 2017;35 Suppl 108:38-42.
  7. Sarica-Kucukoglu R, Akdag-Kose A, KayabalI M, et al. Vascular involvement in Behcet's disease: a retrospective analysis of 2319 cases. Int J Dermatol 2006;45:919-21. https://doi.org/10.1111/j.1365-4632.2006.02832.x
  8. Tascilar K, Melikoglu M, Ugurlu S, Sut N, Caglar E, Yazici H. Vascular involvement in Behcet's syndrome: a retrospective analysis of associations and the time course. Rheumatology (Oxford) 2014;53:2018-22. https://doi.org/10.1093/rheumatology/keu233
  9. Alibaz-Oner F, Karadeniz A, Ylmaz S, et al. Behcet disease with vascular involvement: effects of different therapeutic regimens on the incidence of new relapses. Medicine (Baltimore) 2015;94:e494. https://doi.org/10.1097/MD.0000000000000494
  10. Akgul A. Varicose vein surgery in Behcet's disease. World Clin J Med Sci 2017;1:57-9. https://doi.org/10.5336/worldclin.2017-58624
  11. Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020;8:342-52. https://doi.org/10.1016/j.jvsv.2019.12.075
  12. Ricci MA, Emmerich J, Callas PW, et al. Evaluating chronic venous disease with a new venous severity scoring system. J Vasc Surg 2003;38:909-15. https://doi.org/10.1016/S0741-5214(03)00930-3
  13. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e419S-e496S. https://doi.org/10.1378/chest.11-2301
  14. La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behcet's disease as a model of venous thrombosis. Open Cardiovasc Med J 2010;4:71-7. https://doi.org/10.2174/1874192401004020071
  15. Seyahi E, Yurdakul S. Behcet's syndrome and thrombosis. Mediterr J Hematol Infect Dis 2011;3:e2011026. https://doi.org/10.4084/mjhid.2011.026
  16. Kahn SR. How I treat postthrombotic syndrome. Blood 2009;114:4624-31. https://doi.org/10.1182/blood-2009-07-199174
  17. Desbois AC, Wechsler B, Resche-Rigon M, et al. Immunosuppressants reduce venous thrombosis relapse in Behcet's disease. Arthritis Rheum 2012;64:2753-60. https://doi.org/10.1002/art.34450
  18. Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet's disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clin Rheumatol 2008;27:201-5. https://doi.org/10.1007/s10067-007-0685-z
  19. Magnusson MB, Nelzen O, Volkmann R. Leg ulcer recurrence and its risk factors: a duplex ultrasound study before and after vein surgery. Eur J Vasc Endovasc Surg 2006;32:453-61. https://doi.org/10.1016/j.ejvs.2006.04.015
  20. Akgul A. "Akgul's technique" in repair of deep vein valves in patients with venous insufficiency: editorial. Turkiye Klinikleri J Med Sci 2011;31:771-2. https://doi.org/10.5336/medsci.2011-25938

Cited by

  1. Corrigendum: Characterization of Venous Involvement in Vasculo-Behçet Disease vol.54, pp.1, 2020, https://doi.org/10.5090/kjtcs.20.027e1
  2. Epidemiologic and Etiological Features of Korean Patients With Behçet's Disease vol.28, pp.4, 2021, https://doi.org/10.4078/jrd.2021.28.4.183