Vascular Involvement in Behçet’s Disease: A Retrospective Analysis of Qatar Behçet’s Cohort

Background: Behçet's syndrome (BS) is a chronic systemic inflammatory disorder with vascular involvement representing a severe complication. Despite its high prevalence along the Silk Route, data on vascular Behçet's in Middle Eastern populations remain limited. Purpose: This study evaluates the prevalence, clinical features, and treatment outcomes of vascular BS in Qatar's multinational cohort. Patients and Methods: A retrospective analysis was conducted on 82 BS patients (2016-2024) meeting the International Criteria for Behçet's Disease (ICBD). Vascular involvement was confirmed via imaging (Doppler, CTA/MRA). Demographics, clinical manifestations, and treatment responses were characterized using descriptive analyses, and intervariable associations were statistically examined. Results: Vascular involvement was identified in 20.7% (17/82) of patients, with a male predominance (76.5%) and earlier diagnosis among Arab patients (29.3 vs. 44.3 years, p=0.02). Multivascular involvement was the most common pattern (35.3%), followed by isolated venous thrombosis (29.4%) and isolated arterial involvement (11.8%). Overall, venous disease was the predominant vascular manifestation, occurring either as isolated venous thrombosis or as part of combined arterial-venous involvement. The favorable clinical outcomes observed with corticosteroid-immunosuppressant combination therapy strongly support the early initiation of aggressive immunomodulatory treatment in patients with vascular Behçet's disease. Conclusion: In Qatar, about 1 in 5 patients with Behçet's disease show signs of vascular involvement, with notable differences based on ethnicity and gender. Venous and multivascular involvement are more common, making comprehensive imaging essential. Immunosuppression, particularly steroid-biologic combinations, appears superior to anticoagulation alone. These findings highlight the need for region-specific management protocols in this high-risk population.