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Background: Post-thrombotic syndrome (PTS) and stasis ulcers are late complications of deep vein thrombosis (DVT) in Behçet's syndrome (BS), occurring in up to 60% and 20%, respectively 1. Both complications are difficult to manage and lead to severe socio-economic consequences. Objectives: In this study, we aimed to determine clinical and histopathological characteristics, treatment modalities, and outcome in a group of BS patients having vascular involvement and stasis ulcers. We also looked at the clinical and treatment differences between those with active and healed ulcers. Methods: We studied 51 BS patients with a history of stasis ulcers among 310 patients with vascular involvement followed at a tertiary medical center. Patient's clinical data, histopathological examinations, radiological imaging, and treatment details were obtained from medical records. Ulcer size, anatomical localization, duration, and healing time were defined. The largest ulcer was considered for size evaluation, and remission was defined as having no active ulcer for the past year. Results: Patients' current age was median 45 years and age at vascular onset was median 27 years. Ulcers appeared a median of 4 years after vascular involvement onset. Except from 3 patients, who had only venous insufficiency, all had lower extremity DVT. Among 48 patients, 36 had bilateral DVT and the size of the ulcer did not significantly differ between right and left legs. Additionally, 24 patients (47%) had eye and 6 (12%) had neurological involvement (Table 1). Active ulcers were found in 55% of the patients and in 54% they were recurrent. Among the 51 patients, there were a total of 165 ulcers; median ulcer size was 3 cm, with 41% on the medial malleolus and 25,5% on the anterior surface of tibia (Table 2). Histopathological examination was available in 14 patients. In 71% of patients (10/14), the diagnosis favored stasis dermatitis or occlusive vasculopathy. Treatment included bed rest, local treatments, and compression stockings. Additionally, for stasis ulcer, 36 patients (70%) received immunosuppressive treatment (biological: 45%, non-biological: 63%), and/or glucocorticoid treatment (28%) and 23 of 36 patients had received anti-TNF agents. Intravenous iloprost (49%), Lucilia Sericata for debridement (25%), and skin grafts (4%) were applied. We observed that in 23 patients ulcers healed in median 9 months. In the remaining 28 patients ulcers stayed as unhealed for a median of 11,5 years. There were no apparent associations with the type of management and the severity of venous involvement among those with healed and active ulcer. Conclusion: Stasis ulcers in BS are rare but challenging complications. In our study ulcers were not only seen at medial malleolus and anterior aspect of tibia but also were apparent at different locations like dorsum of foot or lateral malleolus. In contrast to Jung et al. who reported necrotizing vasculitis, our series predominantly showed findings consistent with stasis dermatitis 3. Despite all types of treatment, ulcers persisted actively for a median of 11.5 years in 55% of patients, suggesting that immunosuppressive treatment may not be beneficial in the late stage. REFERENCES: 1 Bettiol, A., Alibaz-Oner, F., Direskeneli, H. et al. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 19, 111–126 (2023). https://doi.org/10.1038/s41584-022-00880-7. 2 Aksoy A, Colak S, Yagiz B, Coskun BN, Omma A, Yildiz Y, Sari A, Atas N, Ilgin C, Karadag Ö, Erden A, Dalkilic E, Bolca N, Ergelen R, Onur MR, Direskeneli H, Alibaz-Oner F. Predictors for the risk and severity of post-thrombotic syndrome in vascular Behçet's disease. J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1451-1459. 3 Jung JY, Kim DY, Bang D. Leg ulcers in Behçet's disease. Br J Dermatol. 2008 Jan;158(1):178-9. Acknowledgements: NIL. Disclosure of Interests: None declared.
Seyahi et al. (Sat,) studied this question.