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Purpose: Behçet's disease (BD) is a complex disorder affecting multiple systems and organs, and gastrointestinal BD is poorly understood. We aimed to identify factors influencing the long-term outcomes of patients with gastrointestinal BD., Methods: Consecutive patients with gastrointestinal BD were analyzed retrospectively. Data on the following clinical characteristics were collected: sex, age at diagnosis, symptoms, endoscopic findings, medical treatments, and surgery. Mucosal healing and surgical rates at 1, 2, and 5 years were evaluated. Log-rank test and Cox proportional hazards regression models were used to evaluate the factors affecting long-term outcomes., Findings: Baseline data of 175 patients with gastrointestinal BD were included. The mean (SD) age at diagnosis was 38.3 (12.9) years. The typical clinical symptoms were oral ulcer (72.6%), abdominal pain (71.4%), and weight loss (41.1%). The most commonly involved location was the ileocecum; isolated oval ulcer was the most common ulcer type. Seventeen patients (9.7%) underwent 18 surgeries after inclusion. The cumulative surgical rates were 8.6% (n/N = 15/175), 8.6% (n/N = 15/175), and 9.1% (n/N = 16/175) in 1, 2, and 5 years, respectively. Data from 101 patients who underwent at least 2 endoscopies were included in the analysis for mucosal healing. Kaplan-Meier curve showed that the cumulative mucosal healing rates at 1, 2, and 5 years were 34.7% (n/N = 35/101), 41.6% (n/N = 42/101), and 61.4% (n/N = 62/101), respectively. We compared cumulative mucosal healing rates between 4 treatment groups, including 5-aminosalicylic acid (3% [n/N = 3/101]), mono-immunosuppressant (31.7% [n/N = 32/101]), combined therapy (36.6% [n/N = 37/101]), and escalation therapy (28.7% [n/N = 29/101]), and found that mono-immunosuppressant achieved earlier mucosal healing than combined therapy (P = 0.0008) and escalation therapy (P = 0.0008). The univariate analysis showed that moderate to severe disease activity (P = 0.013, P = 0.004), diameter of the maximal ulcer >4 cm (P = 0.002), and nonsimple esophageal involvement (P < 0.001) were risk factors, and number of ulcers between 2 and 5 was the protective factor of mucosal healing (P = 0.001). Multivariate regression analysis indicated that nonsimple esophageal involvement (P < 0.001) and the maximal ulcer >4 cm (P = 0.041) were independent risk factors of mucosal healing., Implications: Most patients with gastrointestinal BD need long-term treatment to achieve mucosal healing. The location and size of ulcers have a significant impact on the mucosal healing of gastrointestinal BD., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: To report the early results and technical details of in situ needle fenestration during thoracic endovascular aortic repair (TEVAR)., Materials and Methods: Thirty-seven patients with thoracic aortic disease who underwent TEVAR with in situ needle fenestration in our department between February 2016 and April 2017 were included in this study. Their demographic information, clinical manifestations, periprocedural outcomes, and follow-up results were analyzed., Results: In total, 96.4% of attempted fenestrations were successful (53/55). Fenestration of the left subclavian artery (LSA) was performed in 26 patients, fenestration of either the LSA or brachiocephalic trunk (BCT) plus the left common carotid artery (LCCA) was performed in six patients, and fenestration of the three supra-aortic branches was performed in five patients. In the three-fenestration group with five patients, the procedure was under the protection of a cardiopulmonary bypass. External iliac artery rupture occurred in one case. Cerebrovascular events occurred in three cases, and myocardial infarction occurred in one. One case had a branch stent graft stuck in the brachial artery. During a median follow-up of 21 months, two patients developed retrograde type A dissection, and one was subsequently treated with a stent graft and BCT fenestration. One case presented with numbness in the fingertips of the left hand, and computed tomography angiography (CTA) indicated stenosis of the branch stent in the LSA. CTA examination revealed no endoleaks or expansion of the aortic aneurysms in any of the patients., Conclusions: In situ needle fenestration of endografts in the aortic arch is technically feasible, yielding acceptable short-term results in a selected patient cohort. Further studies are needed to determine mid- and long-term outcomes before more widespread adoption., (Copyright © 2019. Published by Elsevier Inc.)