Abstract 16766: Aortic Dissection and Rupture in Patients With Giant Cell Arteritis: A Single Center Retrospective Review of 195 Consecutive Patients
Background: Aortic aneurysm is a known complication of giant cell arteritis (GCA). However, there is a paucity of data regarding the risk of dissection or rupture. Current guidelines for monitoring and management of aortic aneurysms do not address this unique GCA patient population. The current study aims to define factors associated with the risk of dissection or rupture in this patient population.
Methods: We performed a retrospective review of all GCA patients with aortic aneurysms identified by discharge diagnosis at our institution, between Jan 2000 and Dec 2012. The electronic medical records were reviewed to confirm the diagnosis and identify aortic dissections.
Results: A total of 195 patients met inclusion criteria with history of both GCA and aortic aneurysm. Mean age was 74 years, 62% female, 94% Caucasian. Of 195 cases, 161 (82%) involved the ascending thoracic aorta, 21 (11%) involved the descending thoracic aorta, and 13 (7%) involved the abdominal aorta. There were 14 (7%) aortic dissections and 1 (1%) rupture, all involving the thoracic aorta. Stanford Type A and Type B dissections were seen in 7 (50%) and 7 (50%) of dissections, respectively. Demographics were similar to those without dissection; mean age was 75 years, 60% were female, and 100% were Caucasian. Comorbidities include hypertension (87%), hyperlipidemia (53%), coronary artery disease (60%), and diabetes mellitus (13%). At the time of dissection, 58% were on systemic corticosteroids and 83% were on a beta-blocker. The most common presenting symptoms were chest pain (75%) and syncope (18%). Diagnosis was made by computed tomography, transesophageal echocardiogram, and magnetic resonance angiogram in 80%, 13%, and 7% of cases, respectively. The mean maximal aneurysmal dilation at the time of dissection or rupture was 54±11 mm (range 41 - 80 mm) at the location of dissection or rupture. Emergent surgical repair was required in 57% of cases (88% involving the ascending aorta). Overall mortality at 30 days was 14%.
Conclusion: Aortic dissection and rupture are rare, life threatening complications of GCA. More data are needed to define risk factors for dissection and rupture in patients with GCA related aortic aneurysms and establish screening and treatment guidelines.
- © 2013 by American Heart Association, Inc.