Hubert de Boysson1, Olivier Espitia2, Maxime Samson3, Nathalie Tieulié4, Claude Bachmeyer5, Thomas Moulinet6, Anael Dumont7, Samuel Deshayes7, Bernard Bonnotte3, Christian Agard2, Achille Aouba7. 1. Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France. Electronic address: deboysson-h@chu-caen.fr. 2. Department of Internal Medicine, Nantes University Hospital, Nantes, France. 3. Department of Internal Medicine, Dijon University Hospital, Dijon, France. 4. Department of Internal Medicine, Nice University Hospital, Nice, France. 5. Department of Internal Medicine, Tenon Hospital, Paris, France. 6. Department of Internal Medicine, Nancy University Hospital, Nancy, France. 7. Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France.
Abstract
PURPOSE: To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection. PATIENTS AND METHODS: We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up. RESULTS: A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patients died following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007). CONCLUSION: Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patients died from the aortic dissection. Surgery remains the best predictive factor for survival.
PURPOSE: To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection. PATIENTS AND METHODS: We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up. RESULTS: A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patientsdied following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007). CONCLUSION:Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patientsdied from the aortic dissection. Surgery remains the best predictive factor for survival.
Authors: Cyril Dumain; Jonathan Broner; Erik Arnaud; Emmanuel Dewavrin; Jan Holubar; Myriam Fantone; Benoit de Wazières; Simon Parreau; Pierre Fesler; Philippe Guilpain; Camille Roubille; Radjiv Goulabchand Journal: J Clin Med Date: 2022-05-31 Impact factor: 4.964