Is temporal artery biopsy (TAB) always necessary in suspected giant cell arteritis (GCA)?

Abstract

s / International Journal of Surgery 12 (2014) S13eS117 S114 Department of Surgery, University of Queensland, Queensland, Australia; Imperial College NHS Healthcare Trust, London, UK; Department of Vascular Surgery, Norfolk and Norwich, Norfolk and Norwich, UK. Introduction: Aortic aneurysms represent a significant burden of disease worldwide. Whilst some risk factors for rupture are well established, such as hypertension, smoking and female gender, the impact of season and meteorological variables is less clear. We systematically reviewed the literature in order to conclusively determine whether these variables are associated with aortic aneurysm rupture. Methods: Reviewmethodswereaccording to thePreferredReporting Items for Systematic Reviews and Meta-Analysis guidelines. Data was extracted from all identified studies with regard to study design, geographical location, aortic lesion, sample size, and meteorological variables including season, atmospheric pressure, temperature and daylight hours. Results: 27 studies representing 46,580 patients were investigated. Whilst there is no consensus within the literature, several large studies suggest a statistically significant seasonal variation in the incidence of aortic aneurysm rupture, with winter months broadly conferring a greater degree of risk. There is also some evidence for an association with atmospheric pressure. Associations with temperature and daylight hours, however, remain more controversial. Conclusions: Meteorological and seasonal variables may affect the haemodynamic stability of aortic aneurysms. This may have implications on the epidemiology of aneurysm rupture, and thus influence the provision of vascular services and timing of surgical intervention. 0803: IS TEMPORAL ARTERY BIOPSY (TAB) ALWAYS NECESSARY IN SUSPECTED GIANT CELL ARTERITIS (GCA)? Eva Andreotti, Nicholas Farkas *, Emma Rose McGlone, Aziz Anjum. Epsom and St Helier University Hospitals NHS Trust, Surrey, UK. Introduction: In the diagnosis of GCA, an American College of Rheumatology (ACR) criteria score of three or more has very high sensitivity and specificity. Current guidelines recommend early TAB of sufficient length in all cases of suspected GCA, however recent studies suggest that TAB does not change management in the majority of cases. This retrospective audit aimed to investigate the safety of restricting TAB to only those with indeterminate pre-biopsy ACR score. Methods: We identified 45 consecutive patients undergoing TAB from April 2012 onwards. Notes were analysed for indications for, timing, length and results of TAB, and subsequent patient management. Results: Of those started immediately on steroids, 8/40 (20%) underwent TAB within one week. 21/45 specimens (48%) were one centimetre or longer. Seven patients (16%) had their management changed following biopsy result; of these, 2/17 (11.7%) had pre-biopsy ACR score of 2, 4/19 (21%) of 3, and 1/9 (11%) of 4. Conclusions: In our trust, TAB changes management in patients with prebiopsy ACR score of 2, 3 or 4. Guidelines for specimen length and timing are poorly adhered to, which may influence interpretation of results. At present, TAB cannot be restricted to those with indeterminate pre-biopsy ACR score. 0830: LENGTH OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY AND DEGREE OF STENOSIS: ARE THEY RELATED? Emma Wilton , Naomi Warner *, Patrick Lintott . Oxford University Hospitals NHS Trust, Oxford, UK; Buckinghamshire Healthcare NHS Trust, High Wycombe, Buckinghamshire, UK. Introduction: To determine if the degree of stenosis within the internal carotid artery (ICA) is related to the length of the extracranial ICA. Methods: Retrospective analysis of patients that underwent carotid endarterectomy between September 2009 and August 2013, in one institution, was carried out. Magnetic resonance angiography time-of-flight images were reviewed and the distance between the carotid bifurcation and the base of the skull was recorded bilaterally. The degree of internal carotid artery stenosis measured on preoperative carotid artery duplex scanning, according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, was also recorded. The results were analysed using Pearson's product-moment correlation. Results: A total of 369 patients underwent carotid endarterectomy within the study period. 175 patients were excluded due to insufficient imaging. 194 patients were included (mean age ± SEM 1⁄4 73±1 year; 125 male, 69 female) and their images andcarotidduplex scan resultswere reviewed. 361 pairs of data were analysed using Pearson's correlation (r1⁄40.06, p1⁄40.23). Conclusions: We showed no significant correlation between the length of the extracranial ICA and the degree of stenosis that may develop within it. 0832: MORTALITY FOLLOWING ACUTE NATIVE ARTERY EMBOLECOTMY FOR ARTERIAL EMBOLISM UNRELATED TO PERIPHERAL ARTERIAL DISEASE (PAD): 18 YEAR REVIEW Joel Lambert *, Sobath Premaratne, Anthony Jaipersad, Andy Houghton, Anthony Fox, Kate Merriman. Shrewsbury & Telford NHS Trust, Shrewsbury,