Ascending Aortic Aneurysm Secondary to Isolated Noninfectious Ascending Aortitis

Abstract Isolated noninfectious ascending aortitis (I-NIAA) is increasingly diagnosed at histopathologic review after resection of an ascending aortic aneurysm. PubMed was searched using the term aortitis; publications addressing the issue were reviewed, and reference lists of selected articles were also reviewed. Eleven major studies investigated the causes of an ascending aortic aneurysm or dissection requiring surgical repair: the prevalence of noninfectious aortitis ranged from 2% to 12%. Among 4 studies of lesions limited to the ascending aorta, 47% to 81% of cases with noninfectious aortitis were I-NIAA, more frequent than Takayasu arteritis or giant cell arteritis. Because of its subclinical nature and the lack of “syndromal signs” as in Takayasu arteritis or giant cell arteritis, I-NIAA is difficult to diagnose before complications occur, such as an aortic aneurysm or dissection. Therefore, surgical specimens of dissected aortic tissue should always be submitted for pathologic review. Diagnostic certainty requires the combination of a standardized histopathologic and clinical investigation. This review summarizes the current knowledge on I-NIAA, followed by a suggested approach to diagnosis, management, and follow-up. An illustrative case of an uncommon presentation is also presented. More follow-up studies on I-NIAA are needed, and diagnosis and follow-up of I-NIAA may benefit from the development of diagnostic biomarkers.

[1]  J. Serfaty,et al.  Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. , 2016, Autoimmunity reviews.

[2]  T. Sundt,et al.  Characteristics and Outcomes of Ascending Versus Descending Thoracic Aortic Aneurysms. , 2016, The American journal of cardiology.

[3]  L. Caspary.  Inflammatory diseases of the aorta. , 2016, VASA. Zeitschrift fur Gefasskrankheiten.

[4]  P. Delvenne,et al.  18F-FDG PET/CT in the Management of Aortitis , 2016, Clinical nuclear medicine.

[5]  H. Schaff,et al.  Influence of aortitis on late outcomes after repair of ascending aortic aneurysms. , 2015, The Journal of thoracic and cardiovascular surgery.

[6]  A. Angelini,et al.  Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. , 2015, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[7]  L. Girardi.  Noninfectious aortitis and ascending aneurysms: The tip of the iceberg. , 2015, The Journal of thoracic and cardiovascular surgery.

[8]  M. Sheppard,et al.  Non-infectious aortitis of the ascending aorta: a histological and clinical correlation of 71 cases including overlap with medial degeneration and atheroma—a challenge for the pathologist , 2015, Journal of Clinical Pathology.

[9]  J. Maleszewski.  Inflammatory ascending aortic disease: perspectives from pathology. , 2015, The Journal of thoracic and cardiovascular surgery.

[10]  B. Lytle,et al.  Inflammatory disease of the aorta: patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis. , 2015, The Journal of thoracic and cardiovascular surgery.

[11]  T. Kano,et al.  Rheumatoid arthritis-associated aortitis: a case report and literature review , 2014, SpringerPlus.

[12]  S. Flamm,et al.  Clinical Diagnosis and Management of Large Vessel Vasculitis: Giant Cell Arteritis , 2014, Current Cardiology Reports.

[13]  A. Burke,et al.  Ascending aortitis: a clinicopathological study of 21 cases in a series of 300 aortic repairs , 2014, Pathology.

[14]  Chang-Keun Lee,et al.  Frequency of immunoglobulin G4‐related aortitis in cases with aortic resection and their clinical characteristics compared to other aortitises , 2014, International journal of rheumatic diseases.

[15]  P. Monach.  Biomarkers in vasculitis , 2014, Current opinion in rheumatology.

[16]  L. Cozijnsen,et al.  Infectious aortitis with multiple mycotic aneurysms caused by Streptococcus agalactiae. , 2013, Annals of vascular surgery.

[17]  Jeffery A. Jones,et al.  Pathophysiology of thoracic aortic aneurysm (TAA): is it not one uniform aorta? Role of embryologic origin. , 2013, Progress in cardiovascular diseases.

[18]  W. Schmidt.  Imaging in vasculitis. , 2013, Best practice & research. Clinical rheumatology.

[19]  R. Luqmani.  Large vessel vasculitides: update for the cardiologist , 2012, Current opinion in cardiology.

[20]  A. Bankier,et al.  Insights into imaging of aortitis , 2012, Insights into Imaging.

[21]  V. Katabathina,et al.  Infectious and noninfectious aortitis: cross-sectional imaging findings. , 2012, Seminars in ultrasound, CT, and MR.

[22]  P. Merkel,et al.  Distribution of arterial lesions in Takayasu's arteritis and giant cell arteritis , 2012, Annals of the rheumatic diseases.

[23]  P. Merkel,et al.  Association of Vascular Physical Examination Findings and Arteriographic Lesions in Large Vessel Vasculitis , 2012, The Journal of Rheumatology.

[24]  J. Pu,et al.  Comparison of clinical and pathological characteristics of isolated aortitis and Takayasu arteritis with ascending aorta involvement , 2012, Journal of Clinical Pathology.

[25]  P. Cluzel,et al.  Long-Term Outcome of Arterial Lesions in Behçet Disease: A Series of 101 Patients , 2012, Medicine.

[26]  I. Olivieri,et al.  Aortitis and periaortitis in ankylosing spondylitis. , 2011, Joint, bone, spine : revue du rhumatisme.

[27]  P. Duhaut,et al.  Predictors for pathologically confirmed aortitis after resection of the ascending aorta: A 12-year Danish nationwide population-based cross-sectional study , 2011, Arthritis research & therapy.

[28]  I. Rubinfeld,et al.  Adverse effects of preoperative steroid use on surgical outcomes. , 2011, American journal of surgery.

[29]  B. Mulder,et al.  What Is New in Dilatation of the Ascending Aorta?: Review of Current Literature and Practical Advice for the Cardiologist , 2011, Circulation.

[30]  J. Choi,et al.  A Case of Idiopathic Aortitis Mimicking Severe Aortic Stenosis , 2010, Journal of cardiovascular ultrasound.

[31]  G. Hunder,et al.  The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. , 2010, Arthritis and rheumatism.

[32]  D A Bloch,et al.  The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. , 2010, Arthritis and rheumatism.

[33]  J. Stone,et al.  IgG4‐related systemic disease accounts for a significant proportion of thoracic lymphoplasmacytic aortitis cases , 2010, Arthritis care & research.

[34]  T. Sundt,et al.  Noninfectious Ascending Aortitis: A Case Series of 64 Patients , 2009, The Journal of Rheumatology.

[35]  P. Merkel.  Noninfectious Ascending Aortitis: Staying Ahead of the Curve , 2009, The Journal of Rheumatology.

[36]  I. Marie,et al.  Long-Term Follow-Up of Aortic Involvement in Giant Cell Arteritis: A Series of 48 Patients , 2009, Medicine.

[37]  E. Matteson,et al.  Cardiovascular risk factors and acute-phase response in idiopathic ascending aortitis: a case control study , 2009, Arthritis research & therapy.

[38]  R. di Bartolomeo,et al.  Incidence, etiology, histologic findings, and course of thoracic inflammatory aortopathies. , 2008, The Annals of thoracic surgery.

[39]  E. Batard,et al.  Aortic involvement in recent-onset giant cell (temporal) arteritis: a case-control prospective study using helical aortic computed tomodensitometric scan. , 2008, Arthritis and rheumatism.

[40]  H. Raspe,et al.  EULAR recommendations for the management of large vessel vasculitis , 2008, Annals of the rheumatic diseases.

[41]  R. Virmani,et al.  Aortitis and ascending aortic aneurysm: description of 52 cases and proposal of a histologic classification. , 2008, Human pathology.

[42]  H. Hashimoto,et al.  Differences in atherosclerotic profiles between patients with thoracic and abdominal aortic aneurysms. , 2008, The American journal of cardiology.

[43]  T. Sundt,et al.  Surgical management of ascending aortic aneurysm due to non-infectious aortitis , 2008, Scandinavian cardiovascular journal : SCJ.

[44]  Y. Saiki,et al.  Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. , 2007, The Annals of thoracic surgery.

[45]  K. Maksimowicz-McKinnon,et al.  Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. , 2007, Arthritis and rheumatism.

[46]  W. Edwards,et al.  Surgical Pathology of Noninfectious Ascending Aortitis: A Study of 45 Cases With Emphasis on an Isolated Variant , 2006, The American journal of surgical pathology.

[47]  W. Edwards,et al.  Surgical Pathology of the Ascending Aorta: A Clinicopathologic Study of 513 Cases , 2006, The American journal of surgical pathology.

[48]  A. Burke,et al.  Review of isolated ascending aortitis: differential diagnosis, including syphilitic, Takayasu's and giant cell aortitis , 2006, Pathology.

[49]  G. Hoffman.  Determinants of Vessel Targeting in Vasculitis , 2005, Clinical & developmental immunology.

[50]  G. Hunder,et al.  Aortic Aneurysm and Dissection in Patients With Biopsy-Proven Giant Cell Arteritis From Northwestern Spain: A Population-Based Study , 2004, Medicine.

[51]  J. Pouchot,et al.  Typical and atypical Cogan's syndrome: 32 cases and review of the literature. , 2004, Rheumatology.

[52]  G. Hunder,et al.  Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. , 2003, Arthritis and rheumatism.

[53]  J. Fallon,et al.  Occult active giant cell aortitis necessitating surgical repair. , 2000, The Journal of thoracic and cardiovascular surgery.

[54]  N. Ratliff,et al.  Study of 52 patients with idiopathic aortitis from a cohort of 1,204 surgical cases. , 2000, Arthritis and rheumatism.

[55]  H. Akashi,et al.  Aortic valve replacement for aortic regurgitation caused by aortitis. , 1999, Japanese circulation journal.

[56]  G. Hunder,et al.  Increased Incidence of Aortic Aneurysm and Dissection in Giant Cell (Temporal) Arteritis: A Population-Based Study , 1995, Annals of Internal Medicine.

[57]  M. Endo,et al.  Bilateral coronary ostial stenosis associated with aortitis syndrome. , 1991, Chest.

[58]  D. Cooley,et al.  The morphology of ascending aortic aneurysms. , 1983, Human pathology.

[59]  M. Yacoub,et al.  The surgical pathology of thoracic aortic aneurysms , 1977, Histopathology.

[60]  S Glagov,et al.  Comparison of Abdominal and Thoracic Aortic Medial Structure in Mammals , 1969, Circulation research.

[61]  P. Merkel,et al.  2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. , 2013, Arthritis and rheumatism.

[62]  J. Stone,et al.  Giant cell aortitis of the ascending aorta without signs or symptoms of systemic vasculitis is associated with elevated risk of distal aortic events. , 2012, Arthritis and rheumatism.