Giant cell arteritis-related aortic dissection: A multicenter retrospective study

Hubert de Boysson, Olivier Espitia, Maxime Samson, Nathalie Tieulié, Claude Bachmeyer, Thomas Moulinet, Anael Dumont, Samuel Deshayes, Bernard Bonnotte, Christian Agard, Achille Aouba
Seminars in Arthritis and Rheumatism 2021, 51 (2): 430-435

PURPOSE: To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection.

PATIENTS AND METHODS: We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up.

RESULTS: A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patients died following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007).

CONCLUSION: Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patients died from the aortic dissection. Surgery remains the best predictive factor for survival.

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Christoph Haller

AM wenig Literatur über 'Dissektion' (mehr über Aneurysmata).
Multizentrische, Frankreich.

Dissek pat. Nicht anderen RZA (die das nicht hätten) verglichen.

Monozenter: Dissektion bei 4% der pat. (2.5% I'm Verlauf ED).
Kommt im Median nach 2 Jahren.
25% der Dissek pat. Verstorben. Höhere Überlebenschance wenn OP.

Dissek Weniger Kraniale RZA klinik.
V. A. Dissek im Thorakaler Bereich.


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