Giant cell arteritis of the aorta: Catastrophic complications without a preexisting aneurysm

Abstract

Giant cell arteritis (GCA) is a chronic systemic vasculitis affecting medium and large-sized arteries. A chest X-ray and a multislice computerized tomography can mostly detect anatomical modifications such as aortic aneurysm or wall thickening [1]. Aggressive steroid and immunosuppressive therapy are indicated to control the diffuse disease in the aortic wall. Nevertheless, aortic dissection without a preexisting aneurysm may occur despite medical treatment. While conventional surgery may be life saving, complete removal of the diseased aortic root has been advocated to prevent late additional aortic complications [2]. Knowing the severity and precise extent of the disease in the aortic wall is a determinant factor in planning for the surgical strategy, in order to avoid further life threatening complications. We hereby report a case of acute type A aortic dissection in a patient already treated forGCA.The aortic rootwas left intact during the initial surgery, but was completely removed 10 days later following an early postoperative aorto-atrial fistula.