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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2000 September;19(3):270-275

lingua: Inglese

Aortic aneurysm in patients with autoimmune diseases treated with corticosteroids

Ohara N., Miyata T., Sato O. *, Oshiro H., Shigematsu H.

From the Divi­sion of Vas­cu­lar Sur­gery, Depart­ment of Sur­gery, Facul­ty of Med­i­cine, The Uni­ver­sity of Tokyo, Tokyo, Japan
and the * Divi­sion of Vas­cu­lar Sur­gery, Depart­ment of Sur­gery, Sai­ta­ma Med­i­cal ­School, Sai­ta­ma, Japan


Back­ground. Aor­tic aneu­rysm is a rare but life-threat­en­ing car­di­o­vas­cu­lar com­pli­ca­tion in ­patients with auto­im­mune dis­or­ders. The pur­pose of this study was to clar­i­fy the char­ac­ter­is­tic clin­i­cal fea­tures and the path­o­log­i­cal mech­a­nism of aneu­rys­mal for­ma­tion in those ­patients treat­ed with cor­ti­cos­ter­oids.
Meth­ods. Among 429 ­patients oper­at­ed on for abdom­i­nal aor­tic aneu­rysm dur­ing the past 10 years, six ­patients with auto­im­mune dis­eas­es treat­ed with corti­cos­ter­oids (one with pro­gres­sive system­ic scler­o­sis, one with rheu­ma­toid ­arthritis and four with system­ic lupus ery­them­a­to­sus) were ­reviewed ret­ro­spec­tive­ly. Their data were com­pared with those of 391 ­patients with ath­e­ros­cle­rot­ic aneu­rysms with no auto­im­mune dis­or­ders. The resect­ed aneu­rys­mal walls of the six ­patients were also com­pared his­to­path­o­log­i­cal­ly with those of the last six con­sec­u­tive ­patients in the con­trol group.
­Results. The aver­age age of the ­patients with auto­im­mune dis­ease was young­er than that of the con­trol group (53.8±16.6 vs 71.8±7.8 years; p<0.05). ­Patients with auto­im­mune dis­ease had ­received long-term cor­ti­cos­ter­oid ther­a­py for 15-32 years; mean 22.2±6.5 years. Path­o­log­i­cal exam­ina­tion ­showed that the destruc­tive ­change of the medi­al elas­tic lam­i­na in the auto­im­mune dis­ease group was wider than that in the con­trols. Most ­patients had no com­pli­ca­tions in the post­op­er­a­tive fol­low-up peri­od (5.1±3.2 years), while one ­patient died of rup­ture of a dis­sect­ing aneu­rysm two years after oper­a­tion.
Con­clu­sions. Pro­longed cor­ti­cos­ter­oid treat­ment prob­ably plays a major role in the dis­in­te­gra­tion of con­nec­tive tis­sue of the media, pos­sibly togeth­er with pri­mary aor­tic wall involve­ment and/or vas­cu­lit­ic dam­age in ­patients with auto­im­mune dis­or­ders, which can ­result in aor­tic aneu­rys­mal enlarge­ment.

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