ORIGINAL ARTICLES   

International Angiology 2000 September;19(3):270-275

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

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.