scholarly journals Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110069
Author(s):  
Donatienne de Mornac ◽  
Christian Agard ◽  
Jean-Benoit Hardouin ◽  
Mohamed Hamidou ◽  
Jérôme Connault ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Scan ◽  
Thoracic Aorta ◽  
Lower Limb ◽  
Aortic Surgery ◽  
Limb Ischemia ◽  
Vascular Event ◽  
Descending Thoracic Aorta ◽  
Vascular Events ◽  
Aortic Atheroma

Aims: To identify factors associated with vascular events in patients with giant cell arteritis (GCA). Methods: We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Symptomatic vascular events were defined as the occurrence of any aortic event (aortic dissection or symptomatic aortic aneurysm), stroke, myocardial infarction, limb or mesenteric ischemia and de novo lower limbs arteritis stage 3 or 4. Patients with symptomatic vascular event (VE+) and without were compared, and risk factors were identified in a multivariable analysis. Results: Thirty-nine (15.4%) of the 254 included patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were more frequent in VE+ patients ( p < 0.05), as an abnormal computed tomography (CT)-scan at diagnosis ( p = 0.04), aortitis ( p = 0.01), particularly of the descending thoracic aorta ( p = 0.03) and atheroma ( p = 0.03). Deaths were more frequent in the VE+ group (37.1 versus 10.3%, p = 0.0003). In multivariable analysis, aortic surgery [hazard ratio (HR): 10.46 (1.41–77.80), p = 0.02], stroke [HR: 22.32 (3.69–135.05), p < 0.001], upper limb ischemia [HR: 20.27 (2.05–200.12), p = 0.01], lower limb ischemia [HR: 76.57 (2.89–2027.69), p = 0.009], aortic atheroma [HR: 3.06 (1.06–8.82), p = 0.04] and aortitis of the descending thoracic aorta on CT-scan at diagnosis [HR: 4.64 (1.56–13.75), p = 0.006] were independent predictive factors of a vascular event. Conclusion: In this study on GCA cases with large vessels imaging at diagnosis, aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event. Plain language summary Risk factors for symptomatic vascular events in giant cell arteritis This study was performed to identify the risk factors for developing symptomatic vascular event during giant cell arteritis (GCA) because these are poorly known. We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Patients with symptomatic vascular event (VE+) and without (VE-) were compared, and risk factors were identified in a multivariable analysis. Thirty-nine patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were significantly more frequent in VE+ patients, as an abnormal CT-scan at diagnosis, aortitis, particularly of the descending thoracic aorta and atheroma. Deaths were more frequent in the VE+ group. Among 254 GCA patients, 39 experienced at least one vascular event during follow-up. Aortic surgery, stroke, upper and lower limb ischemia were vascular event risk factors. Aortic atheroma and descending thoracic aorta aortitis on CT-scan were vascular event risk factors. This study on GCA cases with large vessels imaging at diagnosis, showed that aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event.

scholarly journals Endovascular Treatment of Thoracic Aortic Floating Thrombus in Patients Presenting with Acute Lower Limb Ischemia

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Nano Giovanni ◽  
Mazzaccaro Daniela ◽  
Malacrida Giovanni ◽  
Occhiuto Maria Teresa ◽  
Stegher Silvia ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Stent Graft ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Systemic Circulation ◽  
Free Flow ◽  
Descending Thoracic Aorta ◽  
Lower Limb Ischemia ◽  
Floating Thrombus

We report two cases of descending thoracic aorta floating thrombus treated with Bolton Relay thoracic free-flow stent graft. The patients had symptoms of lower limb ischemia; they underwent preoperative angiography and CTscan, then we proceeded with endovascular exclusion of the thrombus from the systemic circulation. At 12 months, the graft was still patent in both patients, without any signs of endoleak.

Use of descending thoracic aorta for lower limb revascularisation

1992 ◽  
Vol 6 (3) ◽  
pp. 255-262 ◽  
Author(s):  
Alain Branchereau ◽  
Pierre-Edouard Magnan ◽  
Philippe Moracchini ◽  
Hugo Espinoza ◽  
Jean-Pierre Mathieu
Keyword(s):  
Thoracic Aorta ◽  
Lower Limb ◽  
Descending Thoracic Aorta

scholarly journals Risk Factors for Long-Term Mortality and Severe Morbidity After Endovascular and Open Aortic Repair in the Descending Thoracic Aorta

2015 ◽  
Vol 62 (3) ◽  
pp. 832-833
Author(s):  
Jeffrey Jim ◽  
Luis A. Sanchez ◽  
Andrea Kahlberg ◽  
Germano Melissano ◽  
Feiyi Jia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Aorta ◽  
Descending Thoracic Aorta ◽  
Severe Morbidity ◽  
Aortic Repair ◽  
Open Aortic Repair ◽  
Long Term Mortality

scholarly journals Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

2019 ◽  
Vol 46 (2) ◽  
pp. 130-132
Author(s):  
Kazuhiro Kurisu ◽  
Satoshi Kimura ◽  
Hiroshi Mitsuo ◽  
Yasutaka Ueno
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Reperfusion Injury ◽  
Lower Limb ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Kidney Injury ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Aortic Repair

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.

P1529Coronary and aortic atheroma are not identical diseases: A calcium score comparative study in 1010 patients with a normal SPECT

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J.-M Foult ◽  
S Katsahian ◽  
C Nevoret ◽  
O Hoffman ◽  
P Sabouret ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Aorta ◽  
Coronary Arteries ◽  
Calcium Score ◽  
Entire Group ◽  
Significant Relation ◽  
Arterial Tree ◽  
Aortic Atheroma ◽  
Best Fitting ◽  
Group 2

Abstract Calcium scores of the coronary arteries (CCS) and – more recently – of the the thoracic aorta (TCS), have been established as risk markers for cardiovascular events. Yet, little is known about the relationship between these two calcium scores. In this study, CCS and TCS were compared in 1010 patients with a normal SPECT. Mean age was 64.5±8.7 yrs with 73.4% of men. CCS and TCS ranged between 0 and 5827 for CCS and from 0 to 58600 for TCS, with means of 281.1 and 1206 respectively. Such a difference was expected since the vascular surface of the thoracic aorta is approximately 5 times larger than that of the coronary arterial tree. Both CCS and TCS increased with the number of risk factors (p=0.000841 and p=0.000579) No significant relation was found between CCS and TCS for the entire group. However, when adopting a best-fitting curve model, 2 populations could be clearly identified: those with predominant TCS (N=552), and those with a- relatively- predominant CCS – (N=458). In each of these two groups, CCS and TCS were significantly related (r=0.63 and 0.69 respectively p<2.2e-12). Both groups had a comparable exposition to smoking and diabetes, but Group1 patients had more dyslipemia and high blood pressure than group 2 patients. Conclusion Calcified atheroma was frequently observed In patients with a normal SPECT, but no significant relation existed between CCS and TCS; patients with a predominant atheroma of the coronary arteries were not the same than patients with a predominant atheroma of the aorta, with both groups having different expositions to risk factors. This suggests that atheroma of the coronary arteries and of the thoracic aorta are close but not identical diseases.

Prognostic risk factors for recurrent acute lower limb ischemia in patients treated with intra-arterial thrombolysis

2020 ◽  
Vol 71 (4) ◽  
pp. 1268-1275 ◽  
Author(s):  
Damir Vakhitov ◽  
Harri Hakovirta ◽  
Eva Saarinen ◽  
Niku Oksala ◽  
Velipekka Suominen
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Prognostic Risk Factors ◽  
Arterial Thrombolysis

scholarly journals Is There a Risk Factor More Responsible for Disaster?

2015 ◽  
Vol 61 (3) ◽  
pp. 245-247
Author(s):  
Carasca Cosmin ◽  
Muresan Vasile Adrian ◽  
Tilea Ioan ◽  
Magdas Annamaria ◽  
Carasca Emilian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Risk Level ◽  
Critical Ischemia ◽  
Medium Risk ◽  
Peripheral Arterial

Abstract Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

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