Background and aim of the study Inflammation of the aortic wall may be respon- sible for the onset of aneurysms and dissections requiring surgical treatment. We evaluate the incidence of aortitis on a selected surgical population searching for any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression and influencing late outcome. Methods From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histo- logical evaluation, providing adequate data in 178 (75%) for a clinical and patho- logical correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2). Results Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%) a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (p = 0.016). A control angio-computed tomography revealed an increased descend- ing aorta diameter in 3 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients.Conclusions Clinically isolated aortitis is extremely frequent in patients with in- flammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathological evaluation of surgical explants and by multimodality im- aging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.
INCIDENCE OF AORTITIS IN SURGICAL SPECIMENS OF THE ASCENDING AORTA: CLINICAL IMPLICATIONS AT FOLLOW-UP
A. De Martino;
2018-01-01
Abstract
Background and aim of the study Inflammation of the aortic wall may be respon- sible for the onset of aneurysms and dissections requiring surgical treatment. We evaluate the incidence of aortitis on a selected surgical population searching for any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression and influencing late outcome. Methods From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histo- logical evaluation, providing adequate data in 178 (75%) for a clinical and patho- logical correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2). Results Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%) a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (p = 0.016). A control angio-computed tomography revealed an increased descend- ing aorta diameter in 3 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients.Conclusions Clinically isolated aortitis is extremely frequent in patients with in- flammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathological evaluation of surgical explants and by multimodality im- aging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
