Non-specific Aortitis Research Articles

Three Presentations of Takayasu’s Arteritis in Hispanic Patients

Takayasu's arteritis (TA) is a medium and large vessel vasculitis, defined as a nonspecific aortitis that usually involves the aorta and its branches Kobayashi and Numano (2002). Its etiology remains unclear, and its complications are diverse and severe, including stenosis of the thoracic and abdominal aorta, aortic valve damage and regurgitation, and stenosis of the branches of the aorta. Carotid stenosis, coronary artery aneurysms, and renal artery stenosis resulting in renovascular hypertension are also reported sequellae of TA Kobayashi and Numano (2002). The disease was first described in Japan, but has also been diagnosed in India and Mexico Johnston (2002). Its incidence in the United States has been quoted as 2.6 patients per 1,000,000 people/year Johnston (2002). In Japan, its incidence is 3.6 patients per 1,000,000 patients/year and prevalence is 7.85 patients per 100,000 per year Morita et al. (1996). The natural history of this disease, which is commonly present in Asian populations, has only recently been studied in Hispanic patients despite the notable incidence and prevalence of TA in Mexican, South American, and Indian populations (Johnston 2002, Gamarra et al. 2010 ). We present three cases of Hispanic patients who presented with TA at Olive-View-UCLA Medical Center (OVMC). We review their clinical and radiographic presentations. Finally, we review the literature to compare the clinical features of our three patients with data regarding the presentation of TA in more traditional Asian populations.

117 Takayasu's Arteritis: Three Presentations in Hispanic Patients and Comparisons with Other Populations

TAKAYASU’S ARTERITIS: THREE PRESENTATIONS IN HISPANIC PATIENTS AND COMPARISONS WITH OTHER POPULATIONS. Ramy Magdy Hanna Wan-ting Yang James Wilson Olive-view UCLA medical center division of nephrology Los Angeles, CA Takayasu’s arteritis (TA) is a medium and large vessel vasculitis, it is defined as a non-specific aortitis that usually involves the aorta and its branches. Its etiology is still unclear and its complications are diverse and severe and include stenosis of the thoracic and abdominal aorta, aortic valve damage and regurgitation, and stenosis of the branches of the aorta. Carotid stenosis, coronary artery aneurysms, and renal artery stenosis resulting in renovascular hypertension are reported sequellae of Takayasu’s arteritis. The disease was first described in Japan but has also been noted to be commonly encountered in India and Mexico. Its incidence in the United States has been quoted as 2.6 patients per 1,000,000 people/year. In Japan its incidence is 3.6 patients per 1,000,000 patients per year and prevalence is 7.85 patients per 100,000 per year. The natural history of this disease, which is commonly present in Asian populations, has only recently been studied in Hispanic patients despite the notable incidence and prevalence of Takayasu’s aortitis in Mexican, South American, and Indian populations. Here we present three cases of Hispanic patients who presented with Takayasu’s arteritis at Olive-view-UCLA medical center (OVMC). We compare and contrast their clinical and radiographic presentations with non-Hispanic patients who presented with this disease. Finally we review the literature to compare and contrast the clinical features of our three patients with data from more traditional Takayasu’s arteritis populations.

Emergent thoracic aortic angioplasty and stenting for middle aortic syndrome in non-specific aortitis

A 61-year-old Japanese male was admitted to hospital due to severe congestive heart failure and pre-renal failure with middle aortic syndrome. The patient was successfully treated with emergent aortic angioplasty and kissing stents implantation whilst in a hemodynamically unstable state. Our experience confirms that stenosis of the descending aorta when treated with catheter intervention may be palliative, however, it was a very effective method for life threatening clinical conditions in the short and mid-term and may be an alternative to surgery.

Maladie de Takayasu révélée par une fuite aortique massive associée à un anévrisme de l’aorte ascendante (À propos de deux cas opérés)

Aortic regurgitation caused by non-specific aortitis is relatively rare, and is now considered as an important risk factor related to mortality. Aortic valve replacement surgery is the only curative treatment. Aneurismal dilatation of the ascending thoracic aorta associated with aortic regurgitation is a rare involvement in Takayasu, there are many difficult problems in surgical treatment of this lesion, because of its inflammatory nature, so steroid therapy before and after surgery is therefore vital. We report the cases of tow young Moroccans women (32–35 years-old) with an ascending aortic aneurism associated to aortic insufficiency. The subsequent evaluation of the entire aorta, demonstrated the presence of multiple steno-occlusive lesions. Aortic valve replacement was performed associated with graft replacement of the ascending aorta without coronary artery reimplantation. Histopathological examination of the ascending aorta and aortic valve, showed findings in favour Takayasu’s arteritis.

Surgical treatment for aortic regurgitation caused by non-specific aortitis

Aortic regurgitation caused by non-specific aortitis is relatively rare, and prosthetic valve detachment after aortic valve replacement has been reported to be one of the most serious complications. The authors investigated the surgical results in patients with aortic regurgitation caused by non-specific aortitis. Between 1978 and 1997, 90 patients with aortic regurgitation secondary to non-specific aortitis underwent surgery. There were 28 males and 62 females. The age of these patients ranged from 19 years to 70 years (mean, 48 years). Sixty-five patients were diagnosed to have Takayasu's arteritis, 10 had Behçet's disease and 15 had aortitis of unknown etiology. The surgical procedures for aortic regurgitation were aortic valve replacement in 62 patients, Bentall-type operation in 27 and remodeling in one. Five patients (5.6%) died during the hospital stay. The follow-up duration ranged from 1 month to 224 months (mean, 98 months). Twenty-one patients died during the follow-up period, and the actuarial survival rate was 83% at 5 years and 68% at 10 years. Prosthetic valve detachment occurred in 12 patients (13.3%). Two patients required a re-aortic valve replacement, eight had a composite graft replacement and two patients underwent a homograft reconstruction. Absence of prosthetic valve detachment was noted in 83% of the patients at 5 years and in 75% at 10 years. The incidence of prosthetic valve detachment was 40% (4/10) in patients with Behçet's disease, 33% (5/15) in aortitis of unknown etiology, 4.6% (3/65) in Takayasu's arteritis and 29% (8/28) in male patients. Surgical techniques for treatment of this condition should be modified for further improvement of the surgical outcome in these patients with Behçet's disease and aortitis of unknown etiology.

Surgical Treatment for Aortic Regurgitation Caused by Non-Specific Aortitis

Aortic regurgitation caused by non-specific aortitis is relatively rare, and prosthetic valve detachment after aortic valve replacement has been reported to be one of the most serious complications. The authors investigated the surgical results In patients with aortic regurgitation caused by non-specific aortitis. Between 1978 and 1997.90 patients with aortic regurgitation secondary to non-specific aortitis underwent surgery. There were 28 males and 62 females. The age of these patients ranged from 19 years to 70 years (mean. 48 years). Sixty-five patients were diagnosed to have Takayasu's arteritis. 10 had Behçet's disease and 15 had aortitis of unknown etiology. The surgical procedures for aortic regurgitation were aortic valve replacement in 62 patients. Bentall-type operation in 27 and remodeling in one. Five patients (5.6%) died during the hospital stay. The follow-up duration ranged from 1 month to 224 months (mean. 98 months). Twenty-one patients died during the follow-up period, and the actuarial survival rate was 83% at 5 years and 68% at 10 years. Prosthetic valve detachment occurred in 12 patients (13.3%). Two patients required a re-aortic valve replacement, eight had a composite graft replacement and two patients underwent a homograft reconstruction. Absence of prosthetic valve detachment was noted in 83% of the patients at 5 years and in 75% at 10 years. The incidence of prosthetic valve detachment was 40% (4/10) in patients with Behçet's disease. 33% (5/15) in aortitis of unknown etiology. 4.6% (3/65) in Takayasu's arteritis and 29% (8/28) in male patients. Surgical techniques for treatment of this condition should be modified for further improvement of the surgical outcome in these patients with Behçet's disease and aortitis of unknown etiology.

Stenosis in the aorta caused by non-specific aortitis: Results of treatment by percutaneous stent placement

Aim: To evaluate the short-term results of percutaneous stent placement in treating stenosis in the aorta caused by non-specific aortitis (Takayasu's disease). Method: Five patients were treated by this method, all of whom had uncontrolled hypertension, haemodynamically significant stenosis in the aorta and a clinically inactive disease. Stents were placed to treat an obstructing dissection in four and recurrent stenosis in one patient. All procedures were carried out via the percutaenous transfemoral route, utilizing self-expanding stents. Results: The lesion was located in the thoracic aorta in three patients and in the abdominal aorta in two patients. The stenosis decreased from 81±2 to 7±3%, the pressure gradient fell from 97±5 to 9±2 mmHg, the blood pressure improved from 200±3/124±2 to 131±2/81±2mmHg, and the drug requirement fell from 4±.2 to 1.3±.3 ( P value for all <0.001). No complication was encountered. At follow-up at 13±4 months, all of the patients had improved clinically. Intimal hyperplasia within the stent was seen in two patients who underwent follow-up angiograms. Conclusion: Percutaneous aortic stenting is useful in treating selected patients with non-specific aortitis. Further information about the long-term behaviour of intimal hyperplasia and the response of stented segments to the aging process needs to be understood before elective stenting in this young patient population can be advocated.

23.13 Surgical treatment for aortic regurgitation caused by non-specific aortitis

23.13 Surgical treatment for aortic regurgitation caused by non-specific aortitis

A case report of Marfan syndrome with non-specific aortitis

A case report of Marfan syndrome with non-specific aortitis

Influence of angiographic morphology on the acute and longer-term outcome of percutaneous transluminal angioplasty in patients with aortic stenosis due to nonspecific aortitis.

We studied the relationship of initial angiographic morphology in patients with aortic stenosis due to nonspecific aortitis and its relationship to immediate and later outcome following percutaneous transluminal angioplasty (PTA). Correlation was performed in 10 successive patients by retrospective analysis. All had clinically inactive nonspecific aortitis and hemodynamically significant aortic stenosis resulting in hypertension or lower limb claudication. Five patients had discrete concentric stenosis; the other five had eccentric stenosis with diseased aortic segments adjacent to the stenosis. The five patients with concentric stenosis (Group I) had primarily successful and uncomplicated PTA with sustained improvement. The five patients (Group II) with eccentric stenosis had initial success in three patients and two initial treatment failures with one patient showing late improvement. Four of these patients developed large intimal flaps. One of these had an aneurysm during follow-up. Follow-up angiograms in five patients showed remodelling with further angiographic and clinical improvement. Eccentricity of the stenosis and diffuse aortic disease correlate unfavorably with immediate outcome of PTA but late improvement may still be seen.

Surgical repair of primary aorto-jejunal fistula associated with non-specific inflammatory abdominal aortic aneurysm

A 28-year-old man with aorto-jejunal fistula associated with primary saccular abdominal aortic aneurysm (AAA) was effectively treated by resection and replacement with polytetraflouroethylene graft. The aetiology was suspected to be a non-specific aortitis, a rare cause of aorto-enteric fistula.

大動脈 （３） 非特異性大動脈炎によるａｏｒｔｉｃ ｖａｌｖｅ ｄｅｔａｃｈｍｅｎｔに対するｔｒａｎｓｌｏｃａｔｉｏｎ法

大動脈 （３） 非特異性大動脈炎によるａｏｒｔｉｃ ｖａｌｖｅ ｄｅｔａｃｈｍｅｎｔに対するｔｒａｎｓｌｏｃａｔｉｏｎ法

Inflammatory abdominal aortic aneurysms: A disease entity?

Sixty inflammatory aortic aneurysms of unknown aetiology were examined by serial sections. The histological findings failed to reveal significant differences in either thoracic or abdominal aneurysms with or without marked adventitial fibrosis. Their identical morphology does not favour the existence of a special disease entity of so-called inflammatory abdominal aortic aneurysms (IAAA). Absence or existence of giant cells of any type, occurrence of plasma cells, eosinophils, granulomas, fibrinoid necrosis and adventitial fibrotic thickening cannot be considered as variables which help in differentiation. IAAA are characterized by a marked predominance of male patients and a rather benign clinical course. They usually affect the age group around 60 years. They are not rare and do not seem to be restricted to certain races. Their aetiology, like that of the cases affecting the thoracic aorta (Takayasu's disease, non-specific aortitis) remains unknown, although autoimmune diseases, the retroperitoneal fibrosis of Ormond and arteriosclerosis may be related. However, on the basis of the present evidence we cannot consider them to be one of these diseases. There are no morphological findings which would justify the separation of IAAA from Takaysu's disease.

Surgical treatment of nonspecific aortitis: Promise, achievement, failure

Surgical treatment of nonspecific aortitis: Promise, achievement, failure

Multiple saccular aortic aneurysms in nonspecific aortitis

FIGURE 1. Aortographic film illustrating 4 of the 8 aneurysms. numbness in her hands and feet. At age 53, she was seen at the National Institutes of Health. The patient had lost 15 pounds in 2 years. She was unable to climb stairs and used a wheelchair. On examination the blood pressure was XXV90 mm Hg; she had a sensorymotor neuropathy, marked ataxia, and thyroid enlargement. Laboratory studies revealed serum positive for cryogiobulins, an elevated sedimentation rate, a positive rheumatoid factor (2:32 dilution) and hypergammaglobulinemia. There was evidence of vasculitis on muscle biopsy. She was treated with prednisone for 2 years without significant therapeutic effect. Her symptoms were essentially unchanged until the week before her final admission when her presenting symptoms began. Temperature now was 101.8~F; bibasilar pulmonary rales and marked sensory deficits in her lower extremities were present. Chest x-ray revealed a mass in the left upper lung field. Aortography revealed multiple aneurysms of the thoracic and abdominal aorta (Fig. I]. Serum cryoglobulins were absent. Multiple blood cultures were sterile. A serologic test for syphilis and a fluorescent antinuclear antibody examination were negative. Hepatitis B core antibody was present. lust before planned aortic surgery, she died suddenly.

Nonspecific aortitis combined with aortic valve regurgitation

Nonspecific aortitis combined with aortic valve regurgitation

Chronic Aortitis Following Furosemide Therapy

A significant increase in histopathologic nonspecific chronic aortitis was found when 100 autopsy specimens from 1965 were compared with series from 1974 and 1980. The chronic aortitis was correlated with furosemide diuretic administration during the last hospitalization. Furosemide is albumin bound, produces vasodilation, and is suspected of having induced a subclinical haptenic immunologic reaction in about one third of those treated.

Unfolding of the aorta (aortitis) associated with pulmonary tuberculosis.

Dilatation of the thoracic aorta was observed in a significant number of normotensive tuberculous patients below the age of 40 years. Histological examination in a selected number of patients showed a non-specific aortitis. It is suggested that aortitis is probably due to an auto-immune response related to pulmonary tuberculosis and that tuberculosis should be recognized as a common cause of unfolding of the aorta in the African.

Reversal of renovascular hypertension caused by nonspecific aortitis after corticosteroid therapy.

Reversal of renovascular hypertension caused by nonspecific aortitis after corticosteroid therapy.

Nonspecific Obliterative Aortitis in Children

Nonspecific Obliterative Aortitis in Children