Background

Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known.

Objectives

The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis.

Methods

This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis.

Results

Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died.

Conclusions

This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.

中文翻译：

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非感染性胸主动脉炎的长期结果和预后

背景

主动脉炎是一组以主动脉炎症为特征的疾病。大血管血管炎是主动脉炎最常见的原因。主动脉炎的长期结果尚不清楚。

目标

本研究的目的是评估非感染性手术胸主动脉炎的长期结果和预后。

方法

这是一项回顾性多中心研究，纳入了 5,666 名接受胸主动脉手术的患者，其中 217 名（3.8%）患有非感染性胸主动脉炎（118 名临床孤立主动脉炎、57 名巨细胞动脉炎、21 名大动脉炎和 21 名患有各种全身性自身免疫性疾病）。通过多变量分析评估与血管并发症和第二次血管手术相关的因素。

结果

主动脉手术的指征为临界尺寸的无症状动脉瘤 (n = 152 [70%])、主动脉夹层(n = 28 [13%]) 和有症状的主动脉瘤(n = 30 [14%])。血管并发症和第二次血管手术的10年累积发生率分别为82.1%（95% CI：67.6%-90.6%）和42.6%（95% CI：28.4%-56.1%）。主动脉弓主动脉炎（HR：2.08；95% CI：1.26-3.44； P = 0.005）与血管并发症独立相关。降胸主动脉炎（HR：2.35；95% CI：1.11-4.96； P = 0.031）和主动脉夹层（HR：3.08；95% CI：1.61-5.90； P = 0.002）与第二次血管手术独立相关，而主动脉炎诊断后使用他汀类药物治疗（HR：0.47；95% CI：0.24-0.90；P = 0.028）可降低其水平。中位随访 3.9 年后，19 名（16.1%）临床孤立主动脉炎患者出现全身炎症性疾病的特征，35 名（16%）患者死亡。

结论

这项多中心研究表明，82% 的非感染性外科胸主动脉炎患者将在 10 年内出现血管并发症。我们指出了识别出后续血管并发症和第二次血管手术风险最高的人群的具体特征。