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ACR 2020 | Daily Highlights
Post-operative outcome in aortitis
COMPARISON OF IMMEDIATE POST-OPERATIVE AND LONG-TERM OUTCOMES IN AORTITIS AND NON-INFLAMMATORY THORACIC AORTIC ANEURYSMS UNDERGOING OPEN SURGICAL REPAIR
Abstract: 0403
Authors: Adam Mayer et al.
Key content:
Around 2–12% of patients who undergo open thoracic aortic aneurysm repair are incidentally found to have aortitis on pathology. How to manage such patients is unknown.
In this single-center cohort study, patients with aortitis were identified by histopathology following open thoracic aortic aneurysm repair. Two comparators who lacked significant inflammation on pathology were matched to each aortitis case by year of surgical repair. Outcomes included length of hospital stay, surgical complications, formation of new vascular abnormalities on CT/MRI imaging, and death.
Results: 162 patients were included: 53 patients with aortitis and 109 matched comparators with similar follow-up time between groups (median follow-up 3.7 vs 3.3 years). Aortitis patients were more likely to be older, female and less likely to have a history of coronary artery disease. 93% of each group had an ascending thoracic aortic aneurysm that was repaired. Patients with aortitis had a significantly longer hospital length of stay even after adjusting for perioperative glucocorticoid use and referral to rheumatology. There was no difference in rates of post-operative complications or surgical revision between groups. On long-term surveillance imaging, no difference was seen in new or worsening aortic aneurysms between groups, but there were significantly more vascular abnormalities in the thoracic aortic branch arteries (carotid, subclavian, brachiocephalic, and celiac arteries) in the aortitis group (39% vs. 11%, P < 0.01).
Relevance:
The study does not address the indication of drug treatment after surgical removal of the inflamed aortal tissue, nor does it mention CRP values before and after surgery. It is not infrequent, that imaging and CRP become normal after replacement of a diseased aorta. However, the study highlights two important facts: 1. Aortitis is an important cause of dissection, and the diagnosis is missed in a substantial percentage of cases despite availability of imaging methods (the true number is likely higher as histological examination is not standard procedure). 2. Subsequent changes in large arteries ask for regular (annual) imaging to readily identify disease relapse.
Zusammenfassung und Kommentar von:
Prof. Dr. Peter Villiger
Bern
