Predictors of dissection in aortic aneurysms from giant cell arteritis

Tanaz A. Kermani, Kenneth J Warrington, Cynthia Crowson, Gene G. Hunder, Steven R Ytterberg, Sherine E. Gabriel, Eric Lawrence Matteson

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Factors associated with dissection from inflammatory aortic aneurysms may be different from those in the general population. Objective: The aim of this study was to evaluate the risk factors for aortic dissection/rupture in patients with giant cell arteritis (GCA) and aortic aneurysms. Methods: A population-based incident cohort of patients with a diagnosis of GCA from 1950 to 2004 was used. All patients with aortic aneurysms diagnosed 1 year prior to GCA diagnosis or any time thereafter were included. Cox proportional hazard models were used to evaluate risk factors for aortic dissection/rupture. Results: The study included 33 patients (91% women) with GCA and aortic aneurysms. Mean age at diagnosis of aortic aneurysm was 83.6 years. There were 27 thoracic aneurysms and 19 abdominal aneurysms. Eight patients developed aortic dissection/rupture (both thoracic and abdominal aorta in 5 cases, thoracic aorta only in 2 cases, and isolated abdominal aorta in 1 case). Older age (hazard ratio [HR], 0.27 per 10 years; 95% confidence interval [CI], 0.09-0.86) and later calendar year at diagnosis of aortic aneurysm (HR, 0.29 per 10 years; 95% CI, 0.13-0.69) were associated with decreased risk of dissection/rupture. Size of the thoracic aneurysm (HR, 1.17; 95% CI, 0.69-1.99) was not associated with dissection/rupture. Histopathology showed active aortitis in 4 of 7 patients with aortic dissection/rupture compared with 0 of 7 patients with aortic aneurysm without dissection/rupture. Conclusions: Aneurysm size was not a predictor of aortic dissection/rupture in this cohort of patients with GCA. The higher frequency of active aortitis in patients with dissection suggests that active inflammation may play a role.

Original languageEnglish (US)
Pages (from-to)184-187
Number of pages4
JournalJournal of Clinical Rheumatology
Volume22
Issue number4
DOIs
StatePublished - Jun 15 2016

Fingerprint

Giant Cell Arteritis
Aortic Aneurysm
Dissection
Aortic Rupture
Aneurysm
Aortitis
Rupture
Abdominal Aorta
Confidence Intervals
Thoracic Aorta
Thorax
Proportional Hazards Models
Population
Inflammation

Keywords

  • Aortic aneurysm
  • Aortic dissection
  • Aortic rupture
  • Giant cell arteritis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Predictors of dissection in aortic aneurysms from giant cell arteritis. / Kermani, Tanaz A.; Warrington, Kenneth J; Crowson, Cynthia; Hunder, Gene G.; Ytterberg, Steven R; Gabriel, Sherine E.; Matteson, Eric Lawrence.

In: Journal of Clinical Rheumatology, Vol. 22, No. 4, 15.06.2016, p. 184-187.

Research output: Contribution to journalArticle

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title = "Predictors of dissection in aortic aneurysms from giant cell arteritis",
abstract = "Background: Factors associated with dissection from inflammatory aortic aneurysms may be different from those in the general population. Objective: The aim of this study was to evaluate the risk factors for aortic dissection/rupture in patients with giant cell arteritis (GCA) and aortic aneurysms. Methods: A population-based incident cohort of patients with a diagnosis of GCA from 1950 to 2004 was used. All patients with aortic aneurysms diagnosed 1 year prior to GCA diagnosis or any time thereafter were included. Cox proportional hazard models were used to evaluate risk factors for aortic dissection/rupture. Results: The study included 33 patients (91{\%} women) with GCA and aortic aneurysms. Mean age at diagnosis of aortic aneurysm was 83.6 years. There were 27 thoracic aneurysms and 19 abdominal aneurysms. Eight patients developed aortic dissection/rupture (both thoracic and abdominal aorta in 5 cases, thoracic aorta only in 2 cases, and isolated abdominal aorta in 1 case). Older age (hazard ratio [HR], 0.27 per 10 years; 95{\%} confidence interval [CI], 0.09-0.86) and later calendar year at diagnosis of aortic aneurysm (HR, 0.29 per 10 years; 95{\%} CI, 0.13-0.69) were associated with decreased risk of dissection/rupture. Size of the thoracic aneurysm (HR, 1.17; 95{\%} CI, 0.69-1.99) was not associated with dissection/rupture. Histopathology showed active aortitis in 4 of 7 patients with aortic dissection/rupture compared with 0 of 7 patients with aortic aneurysm without dissection/rupture. Conclusions: Aneurysm size was not a predictor of aortic dissection/rupture in this cohort of patients with GCA. The higher frequency of active aortitis in patients with dissection suggests that active inflammation may play a role.",
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AU - Crowson, Cynthia

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AU - Gabriel, Sherine E.

AU - Matteson, Eric Lawrence

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KW - Aortic aneurysm

KW - Aortic dissection

KW - Aortic rupture

KW - Giant cell arteritis

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