Inflammatory disease of the aorta: Patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis
Inflammatory disease of the aorta: Patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis
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DOI：
10.1016/j.jtcvs.2014.08.003
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发表时间：
2015-02-01
影响因子：
6
通讯作者：
Lytle, Bruce W.
中科院分区：
文献类型：
--
作者：
Svensson, Lars G.;Arafat, Amr;Lytle, Bruce W.
目的：除了已知的感染性病因外，对主动脉炎性疾病的认识很少。我们分析了一个大系列的受影响的患者谁有组织学诊断，以提高分类的程度，肠炎，使一个更有针对性的approach of treatment.Methods：在1996年和2012年之间，我们对7551例患者进行了手术与升动脉或主动脉弓疾病，其中279例临床诊断为炎症性疾病。结果：156例中巨细胞性动脉炎49例（31%），大动脉炎8例（5.1%），单纯性动脉炎92例（59%），其他7例（4.5%）。还分析了解剖范围的模式，特别是注意到巨细胞性乳腺炎和孤立性乳腺炎具有更广泛的疾病。此外，标本分析提示未识别的既存感染的早期指征。术后死亡率为3.2%（5/156），中风率为1.9%（3/156）。Kaplan-Meier生存率为55%。我们提出了一个疾病的程度和management.Conclusions分类：主动脉炎仍然是一个难题，但是，良好的结果是可以实现的手术。干预应基于对疾病的组织学模式和程度的更清楚的理解，这有助于随后的针对性疾病管理。
Objective: Inflammatory diseases of the aorta, other than those of known infective etiology, are poorly understood. We analyzed a large series of affected patients who had histologic diagnoses with a view to improving the classification of the extent of aortitis to enable a more targeted approach of treatment.Methods: Between 1996 and 2012, we operated on 7551 patients with ascending or aortic arch disease, of whom 279 had clinically diagnosed inflammatory disease. Of these, 156 (2%) were found to have aortitis on histologic examination.Results: Patients were divided into 4 histologically based groups: giant cell aortitis, 31% (49/156); Takayasu arteritis, 5.1% (8/156); isolated aortitis, 59% (92/156); and other, 4.5% (7/156). Patterns of anatomic extent were also analyzed, and in particular it was noted that giant cell aortitis and isolated aortitis had more extensive disease. In addition, specimen analysis suggested early indications of unrecognized preexistent infections. Death after surgery occurred in 3.2%(5/156), and stroke in 1.9%(3/156). Kaplan-Meier survival at 8 years was 55%. We present a classification for disease extent and management.Conclusions: Aortitis continues to be a conundrum; however, good results are achievable with surgery. Intervention should be based on a clearer understanding of the histologic pattern and extent of disease, which helps in subsequent targeted disease management.