Annuloaortic ectasia and arteritis: clinical features, treatments of choice, and causative relations

Abstract The roles that aortitis plays in the development of annuloaortic ectasia (AAE) remain uncertain, while clinical features of AAE in arteritis are largely unknown. This study was designed to highlight the clinical features of AAE, the treatments of choice, and the causative relations between aortitis and AAE. The morphology of the aortic valve leaflets was normal in half of the patients, while the valves were thin and overstretched in the other half. Most patients had an aortic aneurysm. Half of the patients had severe aortic valve insufficiency, and one-quarter of them had dilation of the sinuses of Valsalva. Takayasu arteritis was prone to develop coronary artery lesions, whereas giant cell arteritis were not. Aortic branch lesions in Takayasu arteritis were stenotic or occlusive in 92.9% of the patients, while in giant cell arteritis, they were all dilated lesions. Most patients (94.7%) required surgical treatment with steroid therapy. However, long-term follow-up results showed a higher anastomotic dehiscence rate, particularly in patients with Takayasu arteritis. Further morphometric and pathological research on AAE in arteritis should be undertaken, and more feasible measures should be warranted for preventing postoperative anastomotic dehiscence.

Utilidad de la ecotomografía doppler en el diagnóstico de la arteritis de células gigantes / Utility of the doppler ultrasound in the diagnostic approach of giant cell arteritis

Resumen: La arteritis de células gigantes es una vasculitis sistémica frecuente, especialmente en mayores de 50 años. Ante la sospecha clínica el diagnóstico debe ser confirmado con histología o estudios de imágenes. La biopsia de arteria temporal se considera el gold standard, sin embargo, tiene sus limitaciones, una de ellas es la alta tasa de falsos negativos. El estudio por ecotomografía Doppler permite la visualización de las arterias temporales y en manos experimentadas puede constituir un procedimiento diagnóstico alternativo a la biopsia en el estudio inicial de esta entidad. Esta técnica es de fácil acceso, bajo costo, sin riesgos y no expone al paciente a radiación ionizante. En este trabajo revisamos la utilidad clínica de la ecotomografía Doppler en el estudio de la arteria temporal y sus hallazgos imagenológicos en la aproximación diagnóstica a la arteritis de células gigantes, siendo las características de compromiso el engrosamiento parietal arterial hipoecogénico, habitualmente concéntrico, no compresible.

Abstract: Giant cell arteritis is a frequent systemic vasculitis, especially in patients older than 50 years old. When clinically suspected, the diagnosis should be made on the basis of histology or imaging methods. Temporal artery biopsy is considered the gold standard for the diagnosis but it has some caveats, especially the existence of false negatives. Doppler ultrasound study is a low cost, accessible tool that allows visualization of temporal arteries and, in experienced hands, can replace the biopsy in the initial evaluation of the disease, without the risks of ionizing radiation. In this article we review the clinical utility of the temporal artery Doppler ultrasound and its findings in the diagnostic approach of giant cell arteritis, being characteristic a non-compressible, hypoechoic, most commonly concentric arterial wall thickening.

Inmunopatogenia de las arteritis de grandes vasos / Immunopathogenesis of arteritis of large vessels

La vasculitis es un proceso anatomo-clínico caracterizado por la inflamación y lesión de los vasos sanguíneos. La arteritis de células gigantes y la arteritis de Takayasu se clasifican dentro de las vasculitis de grandes vasos. Ambas se caracterizan por la formación de granulomas. Los linfocitos T CD4 dirigen el daño a los tejidos como un sine qua non en el proceso vasculítico; la activación de los linfocitos T en el ambiente no linfoide de las paredes arteriales requiere la activación de las células dendríticas. Como consecuencia, la activación de monocitos y macrófagos es responsable de un síndrome sistémico inflamatorio. El resultado final es una vasculopatía oclusiva causada por una rápida proliferación de la íntima (arteritis de células gigantes) o la formación de un aneurisma causado por la destrucción de la pared arterial (arteritis de Takayasu).

Vasculitis is a clinical anatomic process characterized by inflammation, and blood vessel damage. Giant cell arteritis and Takayasu arteritis are classified into large-vessel vasculitis. Both are characterized by the formation of granulomas. CD4 T cells direct the tissue damage as a sine qua non in the vasculitic process; activation of T cells in the nonlymphoid environment of the arterial walls requires activation of dendritic cells. As a result, the activation of monocytes and macrophages is responsible for a systemic inflammatory syndrome. The end result is an occlusive vasculopathy caused by a rapid proliferation of the intima (giant cell arteritis), or the formation of an aneurysm caused by the destruction of the arterial wall (Takayasu arteritis).

Arteritis de celulas gigantes: a proposito de cuatro observaciones / Giant cell arteritis: apropos of four cases

A proposito del analisis de cuatro observaciones personales de arteritis de celulas gigantes se realiza una revision etiopatogenica, clinica, paraclinica y terapeutica de las diferentes formas de presentacion de la enfermedad. Se describen las formas tipicas de presentacion de la enfermedad de Horton y la de Takayasu, asi como las formas de superposicion entre ambas