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Lefebvre F, Ross C, Soowamber M, Pagnoux C. Aneurysmal Disease in Patients With Takayasu Arteritis. J Rheumatol 2024; 51:277-284. [PMID: 38101913 DOI: 10.3899/jrheum.2023-0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Takayasu arteritis (TA) leads to stenotic disease. Aneurysmal lesions are rarer. This study assessed the main characteristics of aneurysmal disease in a Canadian cohort of patients with TA. METHODS This monocentric retrospective study included patients with TA followed at the Mount Sinai Hospital Vasculitis Clinic in Toronto. Diagnosis of TA was based on clinical findings and/or satisfied the 1990 American College of Rheumatology classification criteria. RESULTS Seventy-four patients were included. At any time, aneurysmal disease was found in 23 (31%) patients. Median disease duration was 9.0 (IQR 7.0-19.0) years. Prior hypertension (P = 0.02), fever (P = 0.04), and seizure disorders (P = 0.03) were more common. Limb claudication was less frequent (P = 0.01). Persistent and/or new aneurysms were demonstrated in 22/23 patients at follow-up. Thoracic aorta aneurysm (13/22) was most common, followed by abdominal aorta (8/22), subclavian (7/22), and carotid (6/22) artery disease. Aortic valve regurgitation was more frequent (9/23 vs 3/48; P = 0.001). Twenty-one patients had been treated with glucocorticoids (median 6.1 years [IQR 3.7-8.1]). Methotrexate, azathioprine, and leflunomide were repeatedly used. Infliximab (7/23) was used more often (P = 0.04), whereas tocilizumab was received by only 4 patients with aneurysmal disease (P = 0.01). Patients with aneurysms suffered more frequent relapses (2.0 [IQR 0.0-4.0] vs 1.0 [IQR 0.0-2.0], P = 0.04). CONCLUSION Aneurysmal disease was found in a significant proportion of patients with TA. Given that aneurysms may carry a risk of rupture, and are associated with a higher rate of relapse, this finding should be reported systematically in TA studies.
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Affiliation(s)
- Frédéric Lefebvre
- F. Lefebvre, MD, MSc, Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, and Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario;
| | - Carolyn Ross
- C. Ross, PharmD, MD, Vasculitis Clinic, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, and Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario
| | - Medha Soowamber
- M. Soowamber, MD, MSc, C. Pagnoux, MD, MSc, MPH, Vasculitis Clinic, Mount Sinai Hospital, Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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2
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Nakai Y, Nishikawa Y, Saito T, Suda H. Single-stage repair for ascending aortic aneurysm, artery stenosis and occlusion of neck vessels caused by Takayasu arteritis. Interact Cardiovasc Thorac Surg 2022; 35:6617366. [PMID: 35748738 PMCID: PMC9336583 DOI: 10.1093/icvts/ivac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 06/22/2022] [Indexed: 12/05/2022] Open
Abstract
Takayasu arteritis results in a variety of vascular symptoms, and there are some cases in which progressive vascular lesions require surgical intervention. We present a case with ascending aortic aneurysm, right common carotid artery stenosis, left common carotid artery occlusion and left subclavian artery stenosis caused by Takayasu arteritis that was successfully treated with total arch replacement and ascending aorta to right internal carotid artery bypass.
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Affiliation(s)
- Yosuke Nakai
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan
| | - Yusuke Nishikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan
| | - Takayuki Saito
- Department of Cardiovascular Surgery, Kariya Toyota General Hospital , Kariya, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences , Nagoya, Japan
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3
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Chandra P, Nath S. Ortner's Syndrome Associated with Takayasu's Aortoarteritis Identified on Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography. Indian J Nucl Med 2021; 36:212-213. [PMID: 34385800 PMCID: PMC8320817 DOI: 10.4103/ijnm.ijnm_205_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022] Open
Abstract
Cardiovocal syndrome or Ortner's syndrome is hoarseness voice due to left recurrent laryngeal nerve palsy secondary to nerve compression caused by enlarged cardiovascular structures in the mediastinum. We present here an interesting positron-emission tomography/computed tomography image of a patient suspected to have Takayasu's aortoarteritis and presenting with hoarseness of voice.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | - Satish Nath
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
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Bell M, Gandhi R, Shawer H, Tsoumpas C, Bailey MA. Imaging Biological Pathways in Abdominal Aortic Aneurysms Using Positron Emission Tomography. Arterioscler Thromb Vasc Biol 2021; 41:1596-1606. [PMID: 33761759 DOI: 10.1161/atvbaha.120.315812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Michael Bell
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom
| | - Richa Gandhi
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom
| | - Heba Shawer
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom
| | - Charalampos Tsoumpas
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom
| | - Marc A Bailey
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom
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5
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Neurologic complications of diseases of the aorta. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:221-239. [PMID: 33632441 DOI: 10.1016/b978-0-12-819814-8.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neurologic complications of diseases of the aorta are common, as the brain and spinal cord function is highly dependent on the aorta and its branches for blood supply. Any disease impacting the aorta may have significant impact on the ability to deliver oxygenated blood to the central nervous system, resulting in ischemia-and if prolonged-cerebral and spinal infarct. The breadth of pathology affecting the aorta is diverse and neurologic complications can vary dramatically based on the location, severity, and underlying etiology. This chapter outlines the major pathology of the aorta while highlighting the associated neurologic complications. This chapter covers the entire spectrum of neurologic complications associated with aortic disease by beginning with a detailed overview of the spinal cord vascular anatomy followed by a discussion of the most common aortic pathologies affecting the nervous system, including aortic aneurysm, aortic dissection, aortic atherosclerosis, inflammatory and infectious aortopathies, congenital abnormalities, and aortic surgery.
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6
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Toutai C, Berrajaa M, Aissaoui H, Elouafi N, Jabi R, Bouziane M, Latrech H, Housni B, Ismaili N. Rare association of aortoarteritis and pheochromocytoma: A case report. Int J Surg Case Rep 2020; 77:91-95. [PMID: 33157340 PMCID: PMC7649416 DOI: 10.1016/j.ijscr.2020.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Pheochromocytoma is a great masquerador. The coexistence of pheochromocytoma along with both aortoarteritis and renal artery stenosis is very rare. Management of vascular abnormalities is based on the control of catecholamine release. Pheochromocytoma should be included as differential diagnosis of aortoarteritis. Introduction Pheochromocytoma is an uncommon but treatable cause of secondary hypertension, it may present with a wide variety of manifestations. The coexistence of pheochromocytoma and vascular abnormalities is described but rarely reported entity. Presentation of case A 36-year-old man was admitted to our hospital for severe hypertension, examination revealed absent femoral pulses with notion of intermittent claudication. Abdominal computed tomography revealed the presence of a right adrenal pheochromocytoma. CT angiogram showed thickening of the thoracoabdominal aortic wall and the proximal portions of some of its branches with stenosis of more than 50% of the origin of the celiac trunk, bilateral occlusion of the external iliac arteries and trunk stenosis of the right renal artery. The Pheochromocytoma was surgically removed. Discussion Coexistence of pheyochromocytoma and vascular abnormalities especially renal artery stenosis and aortoarteritis seems to be an association rather than a coincidence. Conclusion To the best of our knowledge, the coexistence of pheochromocytoma along with both aortoarteritis and renal artery stenosis has not been reported thus far. The diagnosis, management and potential mechanisms underlying such an association will be discussed in this case.
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Affiliation(s)
- C Toutai
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco.
| | - M Berrajaa
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - H Aissaoui
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - N Elouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - R Jabi
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - M Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - H Latrech
- Department of Endocrinology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - B Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - N Ismaili
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
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Okonogi S, Ohki S, Obayashi T, Yasuhara K, Nagasawa A, Miki T. Single-stage hybrid procedure for ruptured calcified thoracic aortic aneurysm caused by Takayasu's arteritis. Gen Thorac Cardiovasc Surg 2020; 69:610-613. [PMID: 33068257 DOI: 10.1007/s11748-020-01513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
A 68-year-old woman was referred to our hospital because of ruptured severely calcified thoracic aortic aneurysm on chest computed tomography. She was diagnosed with Takayasu's arteritis ~ 30 years ago and was treated with oral steroids daily. We performed total arch repair using uncalcified ascending aorta with open stent-grafting technique, and additional thoracic endovascular aortic repair immediately after open surgery to avoid type Ib endoleak. Continuous hemodiafiltration was needed owing to postoperative transient acute renal failure, following which the patient recovered. She was referred to another hospital 50 days after surgery. A single-stage hybrid procedure for ruptured severe calcified thoracic aortic aneurysm caused by Takayasu's arteritis was required in this case.
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Affiliation(s)
- Shuichi Okonogi
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan.
| | - Satoshi Ohki
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan
| | - Tamiyuki Obayashi
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan
| | - Kiyomitsu Yasuhara
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan
| | - Ayako Nagasawa
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan
| | - Takao Miki
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, 12-1 Tsunatori-Honmachi, Isesaki, Gunma, 372-0817, Japan
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Nagpal P, Agrawal MD, Saboo SS, Hedgire S, Priya S, Steigner ML. Imaging of the aortic root on high-pitch non-gated and ECG-gated CT: awareness is the key! Insights Imaging 2020; 11:51. [PMID: 32198657 PMCID: PMC7083991 DOI: 10.1186/s13244-020-00855-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
The aortic pathologies are well recognized on imaging. However, conventionally cardiac and proximal aortic abnormalities were only seen on dedicated cardiac or aortic studies due to need for ECG gating. Advances in CT technology have allowed motionless imaging of the chest and abdomen, leading to an increased visualization of cardiac and aortic root diseases on non-ECG-gated imaging. The advances are mostly driven by high pitch due to faster gantry rotation and table speed. The high-pitch scans are being increasingly used for variety of clinical indications because the images are free of motion artifact (both breathing and pulsation) as well as decreased radiation dose. Recognition of aortic root pathologies may be challenging due to lack of familiarity of radiologists with disease spectrum and their imaging appearance. It is important to recognize some of these conditions as early diagnosis and intervention is key to improving prognosis. We present a comprehensive review of proximal aortic anatomy, pathologies commonly seen at the aortic root, and their imaging appearances to familiarize radiologists with the diseases of this location.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mukta D Agrawal
- Department of Radiology, Non-invasive Cardiovascular Imaging, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Sachin S Saboo
- Department of Radiology, University of Texas Health Center, San Antonio, TX, USA.
| | - Sandeep Hedgire
- Department of Radiology, Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael L Steigner
- Department of Radiology, Non-invasive Cardiovascular Imaging, Brigham and Women Hospital, Harvard Medical School, Boston, MA, USA
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9
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Ghouri MA, Gupta N, Bhat AP, Thimmappa ND, Saboo SS, Khandelwal A, Nagpal P. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019; 9:S152-S173. [PMID: 31559161 DOI: 10.21037/cdt.2018.09.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Imaging is needed for diagnosis, treatment planning, and follow-up of patients with pathologies affecting upper extremity vasculature. With growth and evolution of imaging modalities [especially CT angiography (CTA) and MR angiography (MRA)], there is need to recognize the advantages and disadvantages of various modalities and obtain the best possible imaging diagnostic test. Understanding various limitations and pitfalls as well as the best practices to minimize and manage these pitfalls is very important for the diagnosis. This article reviews the upper extremity arterial vascular anatomy, discusses the CTA and MRA imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies.
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Affiliation(s)
- Maaz A Ghouri
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Ambarish P Bhat
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Sachin S Saboo
- Department of Radiology, UT Health Science Center, San Antonio, TX, USA
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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10
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Fatehi Hassanabad A, Dagher O, Jefferson HL, Fine NM, Kotha V, Mosher D, Appoo JJ. Delayed dehiscence of modified mechanical Bentall 7 years postsurgery for Takayasu's arteritis. J Card Surg 2019; 34:352-355. [PMID: 30868643 DOI: 10.1111/jocs.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
Following aortic surgery for vasculitis, the incidence and duration of onset of anastomotic breakdown is unclear. A case is presented of a young female patient with Takayasu's arteritis (TA) who was found to have frank dehiscence of a modified Bentall repair 7 years after surgery. The case highlights (i) the lack of normal healing following aortic surgery in TA, and (ii) need to differentiate imaging protocols for patients with defined vasculitis as opposed to degenerative aortic conditions. A recommendation is made for appropriate surveillance imaging modality alternating between computed tomography and magnetic resonance imaging in the often young patient population affected by vasculitis.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Olina Dagher
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Hallie L Jefferson
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Nowell M Fine
- Department of Cardiac Sciences, Section of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Vamshi Kotha
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Department of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Jehangir J Appoo
- Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Abstract
Patients with aortitis often present with nonspecific constitutional symptoms. Due to the fact that aortitis is associated with inflammatory or infectious courses, patients may manifest fever or fever of unknown origin. Such clinical characteristics of aortitis are unavoidably brought about diagnostic dilemmas and might lead to a series of unnecessary work-ups and maltreatment. Therefore, it is important for the clinical physicians and surgeons to understand aortitis presenting with fever of unknown origin to avoid delayed diagnosis and treatment. In this article, clinical and pathological features of aortitis (giant cell arteritis, Takayasu arteritis and infective aortitis, etc.) with fever of unknown origin are described and the differential diagnosis and management policy are discussed.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
| | - Hong Lin
- Department of Cardiology, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian, China
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Muratore F, Crescentini F, Spaggiari L, Pazzola G, Casali M, Boiardi L, Pipitone N, Croci S, Galli E, Aldigeri R, Versari A, Salvarani C. Aortic dilatation in patients with large vessel vasculitis: A longitudinal case control study using PET/CT. Semin Arthritis Rheum 2018; 48:1074-1082. [PMID: 30424972 DOI: 10.1016/j.semarthrit.2018.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate aortic diameter and predictors of aortic dilatation using 18FDG-PET/CT in a longitudinally followed cohort of patients with large vessel vasculitis (LVV) compared with controls. METHODS All consecutive patients with LVV who underwent at least 2 PET/CT scans between January 2008 and May 2015 were included. The first and last PET/CT study was evaluated by a radiologist and a nuclear medicine physician. Diameter and FDG uptake of the aorta was measured at 4 different levels: ascending, descending thoracic, suprarenal and infrarenal abdominal aorta. Twenty-nine age- and sex-matched patients with lymphoma who underwent at least 2 PET/CT scans in the same time interval were selected as controls. RESULTS 93 patients with LVV were included in the study. In the time interval between first and last PET/CT study (median time 31 months), the diameter of the ascending, descending thoracic and suprarenal abdominal aorta significantly increased in LVV patients but not in controls. At last PET/CT, patients with LVV compared with controls had higher diameter of ascending [35.41 (5.54) vs 32.97 (4.11) mm, p = 0.029], descending thoracic [28.42 (4.82) vs 25.72 (3.55) mm, p = 0.007] and suprarenal abdominal aorta, mean [25.34 (7.01) vs 22.16 (3.26) mm, p = 0.005] and more frequently had aortic dilatation [19% vs 3%, p = 0.023]. Significant predictors of aortic dilatation were male sex [OR 7.27, p = 0.001] and, only for GCA, hypertension [OR 6.30, p = 0.031]. Finally, GCA patients with aortic FDG uptake grade 3 at first PET/CT, compared to those with aortic FDG uptake ≤2, had significantly higher aortic diameter. CONCLUSIONS Patients with LVV are at increased risk of aortic dilatation compared with age- and sex-matched controls. Significant predictors of aortic dilatation are male sex and, only for GCA, hypertension. GCA patients with aortic FDG uptake grade 3 are at increased risk of aortic dilatation.
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Affiliation(s)
- Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Crescentini
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Lucia Spaggiari
- Radiology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Giulia Pazzola
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy
| | - Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Luigi Boiardi
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Elena Galli
- University of Modena and Reggio Emilia, Modena, Italy
| | | | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Modena, Italy.
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13
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Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther 2018; 8:S61-S70. [PMID: 29850419 PMCID: PMC5949581 DOI: 10.21037/cdt.2017.09.03] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities.
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Affiliation(s)
- Amy R. Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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14
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Yang KQ, Meng X, Zhang Y, Fan P, Wang LP, Zhang HM, Wu HY, Jiang XJ, Cai J, Zhou XL, Hui RT, Zheng DY, Liu LS. Aortic Aneurysm in Takayasu Arteritis. Am J Med Sci 2017; 354:539-547. [DOI: 10.1016/j.amjms.2017.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/19/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
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15
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de la Rocha JAL, Espinoza LR. Assessing the Risk of Aortic Aneurysm in Takayasu Arteritis. Am J Med Sci 2017; 354:531-532. [PMID: 29208247 DOI: 10.1016/j.amjms.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jose A Leon de la Rocha
- Department of Internal Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Luis R Espinoza
- Department of Internal Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
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16
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Extracranial Carotid Aneurysm in Takayasu Arteritis. J Clin Rheumatol 2017; 23:289. [PMID: 28700525 DOI: 10.1097/rhu.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robinson WP, Detterbeck FC, Hendren RL, Keagy BA. Fulminant Development of Mega-aorta Due to Takayasu's Arteritis: Case Report and Review of the Literature. Vascular 2016; 13:178-83. [PMID: 15996376 DOI: 10.1258/rsmvasc.13.3.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Takayasu's arteritis is a rare inflammatory arteriopathy characterized by segmental involvement of the aorta, its major branches, and, occasionally, the pulmonary arteries. Arterial inflammation generally results in occlusion, but Takayasu's arteritis occasionally presents as aneurysm formation. Takayasu's arteritis generally afflicts young women and is most often characterized by an acute episode of systemic illness and neurologic symptoms secondary to stenoses of the carotid and vertebral circulation. We report an unusual case of Takayasu's arteritis in a 43-year-old man who presented with severe back pain and provide a brief review of the literature.
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Affiliation(s)
- William P Robinson
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Kalisz K, Rajiah P. Radiological features of uncommon aneurysms of the cardiovascular system. World J Radiol 2016; 8:434-448. [PMID: 27247710 PMCID: PMC4882401 DOI: 10.4329/wjr.v8.i5.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/02/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Although aortic aneurysms are the most common type encountered clinically, they do not span the entire spectrum of possible aneurysms of the cardiovascular system. As cross sectional imaging techniques with cardiac computed tomography and cardiac magnetic resonance imaging continue to improve and becomes more commonplace, once rare cardiovascular aneurysms are being encountered at higher rates. In this review, a series of uncommon, yet clinically important, cardiovascular aneurysms will be presented with review of epidemiology, clinical presentation and complications, imaging features and relevant differential diagnoses, and aneurysm management.
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19
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Skeik N, Rodriguez AJ, Engstrom B. Rare Case of Takayasu Arteritis with Concurrent Aneurysmal Dilation and Stenosis. Int J Angiol 2015; 24:244-8. [PMID: 26417195 DOI: 10.1055/s-0035-1549363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Takayasu arteritis is a rare, chronic large vessel vasculitis that primarily affects women aged 10 to 40 years of Asian descent. The inflammatory processes of the disease can result in stenosis and/or occlusion of the aorta and its branches, causing a wide range of symptoms. Rarely, damage of the elastic lamina or muscular media can cause aneurysmal dilation of the affected vessel. Diagnosis is based on the clinical presentation, laboratory proof of inflammation, and imaging finding of wall thickening in the acute phase and later arterial stenosis or occlusion. Management includes disease control with immunosuppression and some patients might require revascularization. Here, we present a rare case of Takayasu arteritis with both right common carotid artery aneurysmal dilation and stenosis at a conforming site. Although aneurysmal dilation has been sparsely reported in the Takayasu arteritis literature, our case may represent the distinct finding of concomitant dilation and stenosis in this disease.
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Affiliation(s)
- Nedaa Skeik
- Department of Vascular Medicine, Anticoagulation and Thrombophilia Clinic, Minneapolis Heart Institute, Minneapolis, Minnesota
| | | | - Bjorn Engstrom
- Department of Radiology, Vascular and Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota
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20
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Chougule A, Bal A, Das A, Jain S, Bahl A. Uncommon associations and catastrophic manifestation in Takayasu arteritis: an autopsy case report. Cardiovasc Pathol 2014; 23:313-6. [PMID: 24908552 DOI: 10.1016/j.carpath.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022] Open
Abstract
Takayasu arteritis, a chronic inflammatory vasculitis affecting aorta and its major branches, is complicated by stenosis, occlusion, and aneurysm formation. The aneurysm formation and subsequent complications such as heart failure, aortic regurgitation, and aneurysm rupture can be fatal. The aortic aneurysm rupture is a rare and fatal complication with only a few cases reported in the English literature. The involvement of coronary artery in Takayasu occurs in about 10% patients, and the coronary artery aneurysm is the least common manifestation. Here, we describe a case of Takayasu arteritis with abdominal aortic aneurysm rupture and coronary artery aneurysm. This patient also had associated systemic inflammatory diseases like sarcoidosis and Hashimoto's thyroiditis.
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Affiliation(s)
- Abhijit Chougule
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector - 12, Chandigarh- 160012, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector - 12, Chandigarh- 160012, India.
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector - 12, Chandigarh- 160012, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector - 12, Chandigarh- 160012, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector - 12, Chandigarh- 160012, India
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21
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Yannoutsos A, Mercier O, Messas E, Safar ME, Blacher J. [Aneurysmal rupture complicating aortitis: a case report]. ACTA ACUST UNITED AC 2014; 39:195-202. [PMID: 24637031 DOI: 10.1016/j.jmv.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
Tropical aortitis is a rare and poorly described aortic disease, sometimes confounded with Takayasu's disease, mainly in people from Africa. In this case report, the panaortic aneurysmal disease in a young woman from Haiti, first diagnosed after a work-up on renovascular hypertension, would appear to approach this particular arterial disease with no clinical, radiological or biological argument for an infectious etiology. The initially suspected diagnosis of Takayasu's disease had to be rethought because of the presence of several saccular aneurysms extending from the aortic arch to the infrarenal aorta, rarely described in Takayasu's aortitis. Expert opinions from vascular surgeons and clinicians tagged this aortic disease as similar to tropical aortitis which remained asymptomatic for more than a decade. Hypertension was managed with successful balloon angioplasty of the left renal artery stenosis and anti-hypertensive combination therapy. Surgical management of the extended aortic aneurysms was not proposed because of the stability and asymptomatic nature of the aneurysmal disease and the high risk of surgical morbidity and mortality. More than ten years after diagnosis, the course was marked with inaugural and sudden-onset chest pain concomitant with contained rupture of the descending thoracic aortic aneurysm. This case report underlines the persistent risk of aneurysmal rupture and the importance of an anatomopathological study for the diagnosis of complex aortic disease.
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Affiliation(s)
- A Yannoutsos
- Unité HTA, centre de diagnostic et de thérapeutique, prévention et thérapeutique cardiovasculaires, faculté de médecine, université Paris-Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, place du Parvis-Notre-Dame, 75004 Paris, France
| | - O Mercier
- Département de chirurgie thoracique, vasculaire et transplantation cardio-pulmonaire, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France
| | - E Messas
- Pôle cardiovasculaire, service de médecine vasculaire-HTA, hôpital européen G.-Pompidou, 75908 Paris cedex 15, France
| | - M E Safar
- Unité HTA, centre de diagnostic et de thérapeutique, prévention et thérapeutique cardiovasculaires, faculté de médecine, université Paris-Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, place du Parvis-Notre-Dame, 75004 Paris, France
| | - J Blacher
- Unité HTA, centre de diagnostic et de thérapeutique, prévention et thérapeutique cardiovasculaires, faculté de médecine, université Paris-Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, place du Parvis-Notre-Dame, 75004 Paris, France.
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22
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Skeik N, Rumery KK, Udayakumar PD, Crandall BM, Warrington KJ, Sullivan TM. Concurrent Takayasu arteritis with common variable immunodeficiency and moyamoya disease. Ann Vasc Surg 2013; 27:240.e13-8. [PMID: 23380559 DOI: 10.1016/j.avsg.2012.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/31/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
Takayasu arteritis is a rare, chronic form of large vessel vasculitis that characteristically involves the aorta and its branches. Its origin and disease process are currently unknown, although T lymphocytes and, most recently, B cells are thought to play a role. Common variable immunodeficiency (CVID) is a collection of heterogeneous disorders resulting in an antibody deficiency and recurrent infections, and is the most common symptomatic primary immunodeficiency disorder. This report presents a unique case of possible Takayasu arteritis with a history of CVID in a young man admitted with multiple cerebrovascular accidents. Takayasu arteritis may serve as the main cause of this presentation. The rarity of this case is further accentuated by the presence of moyamoya disease. Finally, the possible disease process and novel treatment of Takayasu arteritis is discussed briefly.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Abbott Northwestern Hospital/Minneapolis Heart Institute, Minneapolis, MN 55407, USA.
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23
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Kota SK, Kota SK, Meher LK, Jammula S, Panda S, Modi KD. Coexistence of pheochromocytoma with uncommon vascular lesions. Indian J Endocrinol Metab 2012; 16:962-971. [PMID: 23226643 PMCID: PMC3510968 DOI: 10.4103/2230-8210.103000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. MATERIALS AND METHODS From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. RESULTS Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. CONCLUSION There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - Siva Krishna Kota
- Department of Anesthesia, Central Security hospital, Riyadh, Saudi Arabia
| | - Lalit Kumar Meher
- Department of Medicine, MKCG Medical College, Berhampur, Orissa, India
| | - Sruti Jammula
- Department of Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Orissa, India
| | - Sandip Panda
- Department of Cardiology, JIPMER, Puducherry, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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24
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Extracellular Matrix Remodeling in Takayasu's Arteritis: Role of Matrix Metalloproteinases and Adventitial Inflammation. Arch Med Res 2012; 43:406-10. [DOI: 10.1016/j.arcmed.2012.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/16/2012] [Indexed: 11/23/2022]
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25
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26
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Jain D, Dietz HC, Oswald GL, Maleszewski JJ, Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol 2011; 20:15-25. [PMID: 19926309 DOI: 10.1016/j.carpath.2009.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/02/2009] [Accepted: 09/25/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ascending aortic diseases (aneurysms, dissections, and stenosis) and associated aortic valve disease are rare but important causes of morbidity and mortality in children and young adults. Certain genetic causes, such as Marfan syndrome and congenital bicuspid aortic valve disease, are well known. However, other rarer genetic and nongenetic causes of aortic disease exist. METHODS We performed an extensive literature search to identify known causes of ascending aortic pathology in children and young adults. We catalogued both aortic pathologies and other defining systemic features of these diseases. RESULTS We describe 17 predominantly genetic entities that have been associated with thoracic aortic disease in this age group. CONCLUSIONS While extensive literature on the common causes of ascending aortic disease exists, there is a need for better histologic documentation of aortic pathology in rarer diseases.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Restrepo CS, Ocazionez D, Suri R, Vargas D. Aortitis: Imaging Spectrum of the Infectious and Inflammatory Conditions of the Aorta. Radiographics 2011; 31:435-51. [DOI: 10.1148/rg.312105069] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Imaging of primary and secondary inflammatory diseases involving large and medium-sized vessels and their potential mimics: a multitechnique approach. AJR Am J Roentgenol 2010; 194:848-56. [PMID: 20173169 DOI: 10.2214/ajr.09.3367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate multitechnique imaging findings in patients with primary and secondary vasculitides involving large and medium-sized vessels and their mimics. CONCLUSION Large and medium-sized vessels are affected by many primary and secondary inflammatory disorders or mimicking conditions, often presenting similar imaging characteristics. Knowledge of distinctive imaging features such as location, length, and degree of vessel wall enhancement as well as the particular clinical settings will help the clinician in appropriately narrowing down the differential diagnosis.
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29
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Update on Multidetector Computed Tomography Angiography of the Abdominal Aorta. Radiol Clin North Am 2010; 48:283-309, viii. [PMID: 20609875 DOI: 10.1016/j.rcl.2010.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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30
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Ghannouchi Jaafoura N, Khalifa M, Rezgui A, Alaoua A, Ben Jazia E, Braham A, Kechrid C, Mahjoub S, Ernez S, Boughzela E, Ben Farhat M, Letaief A, Bahri F. La maladie de Takayasu dans la région centre de la Tunisie. À propos de 27 cas. ACTA ACUST UNITED AC 2010; 35:4-11. [DOI: 10.1016/j.jmv.2009.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 09/09/2009] [Indexed: 12/19/2022]
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31
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Affiliation(s)
- Heather L Gornik
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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32
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Baril DT, Carroccio A, Palchik E, Ellozy SH, Jacobs TS, Teodorescu V, Marin ML. Endovascular Treatment of Complicated Aortic Aneurysms in Patients with Underlying Arteriopathies. Ann Vasc Surg 2006; 20:464-71. [PMID: 16779505 DOI: 10.1007/s10016-006-9091-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 05/03/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
Patients with arteriopathies including giant cell arteritis, Marfan syndrome, and Takayasu's disease are at risk for aneurysmal degeneration of the aorta. Aortic repair has been recommended for these patients to prevent rupture. The purpose of this study was to examine outcomes following endovascular stent graft (EVSG) repair of aortic aneurysms in this patient population. Over an 8-year period, 11 patients (six men, five women) with arteriopathies underwent endovascular aortic repair. The mean age was 50 (range 15-81). Diseases included Marfan syndrome (n = 6), Takayasu's disease (n = 3), and giant cell arteritis (n = 2). Success of EVSG repair was evaluated per the reporting standards of the Society for Vascular Surgery/American Association for Vascular Surgery. Follow-up was a mean of 28.9 months (range 3-68). Six patients underwent EVSG repair of the thoracic aorta, four underwent EVSG repair of the abdominal aorta, and one underwent a staged repair of the thoracic and subsequently the abdominal aorta. Six true aneurysms and six pseudoaneurysms were repaired. Eight patients had previous aortic surgery, including four with multiple aortic operations. For the 12 aneurysms treated, technical success was achieved in 11 (91.7%). One technical failure occurred due to a small iliac access vessel, requiring an eventual iliac conduit for insertion. Early complications (<30 days) occurred in three patients. Type I or III endoleak developed following two repairs (16.7%). Aneurysm expansion occurred following one repair (8.3%). No aneurysm-related deaths occurred during follow-up. EVSG repair of aortic aneurysms is feasible and can be safely performed in patients with arteriopathies. Long-term durability in this younger group of patients who carry an ongoing risk of arterial degeneration remains to be determined.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Angioplasty, Balloon
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/therapy
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/etiology
- Aortic Aneurysm, Thoracic/therapy
- Aortography
- Blood Vessel Prosthesis Implantation
- Feasibility Studies
- Female
- Follow-Up Studies
- Giant Cell Arteritis/complications
- Giant Cell Arteritis/diagnostic imaging
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Male
- Marfan Syndrome/complications
- Marfan Syndrome/diagnostic imaging
- Middle Aged
- Recurrence
- Retrospective Studies
- Stents
- Takayasu Arteritis/complications
- Takayasu Arteritis/diagnostic imaging
- Tomography, X-Ray Computed
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Affiliation(s)
- Donald T Baril
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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Schirmer M, Duftner C, Seiler R, Dejaco C, Fraedrich G. Abdominal aortic aneurysms: an underestimated type of immune-mediated large vessel arteritis? Curr Opin Rheumatol 2006; 18:48-53. [PMID: 16344619 DOI: 10.1097/01.bor.0000198001.35203.36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To review recent studies on the immune-mediated pathogenesis of abdominal aortic aneurysms, opening a wide field for possible new therapeutic approaches. RECENT FINDINGS Immune-mediated processes including involvement of neutrophils, interferon-gamma producing T cells and proinflammatory cytokines play an important role especially in the initiation of abdominal aortic aneurysm disease. C-reactive protein was associated with aneurysm size and is possibly produced by the aneurysmal tissue itself. From the clinical perspective, both inflammatory and noninflammatory abdominal aortic aneurysms are associated with various autoimmune diseases. Preliminary data of F-FDG positron emission tomography imaging of abdominal aortic aneurysms suggest focal uptake of F-FDG within the aneurysm wall in patients with either large, rapidly expanding or symptomatic aneurysms that are prone to rupture. Thus basic research findings and clinical research focusing on the underlying immune-mediated mechanisms of abdominal aortic aneurysms will likely pave the way for new medical therapies in the future. In animal models the effects of rapamycin as an immunosuppressive agent, modulation of estrogen receptors by tamoxifen as well as gene therapy using decoy oligonucleotides binding to the transcription factor ets has already proved helpful in decreasing aneurysm expansion rates. SUMMARY Pathophysiological, immunogenetical and interventional studies support the concept of abdominal aortic aneurysm as an immune-mediated process, which will help to identify more laboratory and imaging signs of development in the future. Further research will now assess the possible benefit of antiinflammatory therapeutic approaches, especially in patients with small abdominal aortic aneurysms.
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Affiliation(s)
- Michael Schirmer
- Department of Internal Medicine, Innsbruck Medical University, Austria, Innsbruck Medical University, Austria.
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Serafino G, Vroegindeweij D, Boks S, van der Harst E. Mycotic Aneurysm of the Celiac Trunk: From Early CT Sign to Rupture. Cardiovasc Intervent Radiol 2005; 28:677-80. [PMID: 15999241 DOI: 10.1007/s00270-004-0011-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of the rapid development and rupture of a mycotic celiac trunk aneurysm. Initially on multislice computed tomography (ms-CT) there was a normal celiac trunk with minimal haziness of the surrounding fat. Only 2 weeks later the patient went into hypovolemic shock due to a ruptured celiac aneurysm. Although aneurysms of the visceral arteries are rare, they are of major clinical importance as they carry a life-threatening risk of rupture. This case illustrates the use of ms-CT in detecting and evaluating visceral aneurysms, in order to prevent emergency operation.
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Affiliation(s)
- Gianpiero Serafino
- Department of Radiology, Medical Centre Rijnmond-Zuid, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands.
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35
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Kieffer E, Chiche L, Bertal A, Koskas F, Bahnini A, Blã Try O, Cacoub P, Piette JC, Thomas D. Descending Thoracic and Thoracoabdominal Aortic Aneurysm in Patients with Takayasu's Disease. Ann Vasc Surg 2004; 18:505-13. [PMID: 15534728 DOI: 10.1007/s10016-004-0073-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
From June 1974 to December 2001 we performed operative treatment on 33 patients with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease. There were 25 men and 8 women with a mean age of 40.2A years (range 16-64A years). Nineteen patients came from North Africa, 6 were from France, and 8 were from various locations in the world. The revealing symptom was hypertension in 12 cases, thoracic or abdominal pain in 7, isolated inflammatory syndrome in 5, neurologic or ocular manifestations in 3, rupture in 3, and embolization to the lower extremity in 1. In the remaining two cases discovery was coincidental. The aneurysm was confined to the thoracic aorta in 10 cases and involved both the thoracic and abdominal aorta in 23 cases. There were 8 type I, 6 type II, 4 type III, and 5 type IV aneurysms according to Crawford's classification. Two patients had undergone previous repair of the thoracoabdominal aorta. Four patients required first-stage treatment of a renal artery lesion to control hypertension. Six patients had associated aneurysms of the proximal aorta, including five treated via the distal elephant trunk technique in first-stage procedures. Aneurysm repair consisted of prosthetic replacement of the thoracoabdominal aorta in 31 cases, exclusion bypass in 1 case, and stent graft placement in 1 case. The procedure was performed with cross-clamping alone in 13 cases, distal perfusion in 17 cases, and deep hypothermic circulatory arrest in 3 cases. Twenty patients (61%) had associated renal and/or intestinal artery lesions that were treated during the same procedure as that for the thoracoabdominal aorta in 19 patients (58%). A total of 24 procedures were performed on renal arteries (17 revascularizations, 7 nephrectomies). Associated supraaortic trunks lesions were present in 15 patients (45%) and were treated in 12 patients, including 8 in first-stage procedures prior to thoracoabdominal aortic aneurysm repair. Three patients died of multiple organ failure, after reoperation in two cases and infection in one case involving prior long-term corticosteroid therapy. Three patients developed paraplegia, including one who had undergone emergency treatment following rupture. Two patients required reoperation, for hematoma in one case and bowel necrosis in one. Four patients developed respiratory complications requiring artificial ventilation for more than 48 hr. During follow-up, two patients died from complications after repair of the proximal aorta and one patient required nephrectomy. Despite the extent of aneurysmal lesions and high frequency of association with visceral and supraaortic vessel lesions, the outcome of surgery in patients presenting with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease was satisfactory.
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Affiliation(s)
- Edouard Kieffer
- Department of Vascular Surgery, Internal Medicine, and Cardiology, Pitié-Salpêtrière University Hospital Center, Assitance Publique-Hopitaux de Paris (AP-HP), Paris, France.
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36
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Reichman EF, Weber JM. Undiagnosed Takayasu's arteritis mimicking an acute aortic dissection. J Emerg Med 2004; 27:139-42. [PMID: 15261355 DOI: 10.1016/j.jemermed.2004.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2002] [Revised: 11/21/2003] [Accepted: 02/05/2004] [Indexed: 11/21/2022]
Abstract
Takayasu's arteritis (TA) is a vasculitis involving the aorta and its branches. We report a case of undiagnosed TA that presented to the Emergency Department with a chief complaint of chest pain and signs consistent with an aortic dissection.
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Affiliation(s)
- Eric F Reichman
- Emergency Department, University of Texas at Houston Medical School, Houston, Texas, USA
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Abstract
The past year has seen some notable publications in the field of vasculitis epidemiology. The appearance of reports from several different parts of the world has permitted comparisons to be made. In Europe, Wegener granulomatosis appears to be more common at high latitudes, whereas microscopic polyangiitis shows the reverse pattern. Kawasaki disease is most common in Japan. In China, the United States, and the United Kingdom, the incidence is lower, but the incidence appears to be increasing globally. Studies of infectious triggers continue to be disappointingly negative. Immunogenetic associations with cytokine polymorphisms are beginning to be reported.
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Affiliation(s)
- Richard A Watts
- Department of Rheumatology, Ipswich Hospital, NHS Trust, Ipswich, UK
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Affiliation(s)
- B T Nguyen
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
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Stegeman CA, Kallenberg CG. Clinical aspects of primary vasculitis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 2001; 23:231-51. [PMID: 11591100 DOI: 10.1007/s002810100079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C A Stegeman
- Department of Internal Medicine/Division of Nephrology, University Hospital Groningen, Faculty of Medical Sciences, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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