Endovascular aortic repair is feasible. In the Cleveland clinic experience in autoimmune aortitis of the ascending aorta, 37 patients had distal aorta Stent grafting. Success was 100%. In a mean follow up of ~ 4 years only one patient needed re intervention for endo leak.
I think endovascular procedure (EVAR) is best choice after remission of inflamatory phase of disease
Best regards
Τhe remission of the inflamatory activity is a must! The question is: How much time we should continue after the graft placement.
My recommendation is EVAR. Better results will be obtained when the decision is at remission. However, if it has to be an emergency procedure, immunosuppression with high dose steroids is to be provided.
Endo repair along with monitoring and control of autoimmune response.
Some interesting findings regarding autoimmune aortitis:
- the diagnosis is made postoperative in more than 80 % of the patients
- the most common type is isolated aortitis in which the inflammation is localized to the aorta with no systemic symptoms
- 12% of patients with giant cell arteritis who had aortic surgery had negative pathology for aortitis
- giant cell aortitis are characterized by skip lesions.
- immunosuppressant had no effect on reintervention rate.
- endovascular intervention is feasible is those patients
We presented our experience in the American Heart Association 13
http://circ.ahajournals.org/cgi/content/meeting_abstract/128/22_MeetingAbstracts/A16022
First one should be very sure if repair is needed at all. A biomechanical rupture risk assessment could help to clarify that, see our recent retrospective study about this concept in T.C. Gasser, A. Nchimi, J. Swedenborg, J. Roy, N. Sakalihasan, D. Böckler, A. Hyhlik-Dürr. A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: Method and retrospective validation. Eur. J. Vasc. Endovasc. Surg. 2014
https://www.researchgate.net/profile/Thomas_Gasser3/publication/259881358_A_Novel_Strategy_to_Translate_the_Biomechanical_Rupture_Risk_of_Abdominal_Aortic_Aneurysms_to_their_Equivalent_Diameter_Risk_Method_and_Retrospective_Validation/file/9c96052f486d351cb2.pdf?ev=pub_int_doc_dl&origin=publication_list&inViewer=true
Many other references about this method are also given in this artivle.
Note that you can order a biomechanics diagnosis report at
http://www.vascops.com/en/vascops-diagnosis_service.html
and will receive it within 24 hours.
Finally, there is a chance that this technology will be available in LKH Villach soon.
Article A Novel Strategy to Translate the Biomechanical Rupture Risk...
I agree that endovascular procedure must be a recommendation but only after remission of inflamatory phase of disease .
in my experience i prefer Opel treatment, because it is the only possibility to achieve an specimen of aortic wall for histology. however you must consider the clinical condition of the patient. Only if there is a high riso of rupture you can do surgery o endosurgery out of the phase of remission of patology.
Yes, after remission of disease. But, it can reoccur too in short span ot time and complicate the issue.
Relationship of Fluoroquinolone Use and Development of Aortic Aneurysms and Dissection
Although not in the context of Giant cell arteritis, one should avoid using fluoroquinolones in such patients due to risk of development of aortic aneurysms (1), and their dissection (2).
1. Article Association of Fluoroquinolone Use With Short-term Risk of D...
2. Article Fluoroquinolone use and risk of aortic aneurysm and dissecti...
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