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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe aorta and its branches are involved in about 30% of patients with giant cell arteritis (GCA) [Nuenningh-off DM et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2003]. Patients with GCA have a 17-fold risk for developing a thoracic aortic aneurysm and a 2.4-fold risk for developing an abdominal aneurysm [Evans JM et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 1995]. Aortic aneurysm in GCA is poorly understood, with few data on risk and predictors of dissection and rupture. The current guidelines for monitoring and management of aortic aneurysm do not address this unique population.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVasculitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVasculitis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe aorta and its branches are involved in about 30% of patients with giant cell arteritis (GCA) [Nuenninghoff DM et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2003]. Patients with GCA have a 17-fold risk for developing a thoracic aortic aneurysm and a 2.4-fold risk for developing an abdominal aneurysm [Evans JM et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 1995]. Aortic aneurysm in GCA is poorly understood, with few data on risk and predictors of dissection and rupture. The current guidelines for monitoring and management of aortic aneurysm do not address this unique population.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis retrospective study, presented by Ashima Makol, MD, Mayo Clinic, Rochester, Minnesota, USA, had 3 objectives: (1) to systematically study aortic dissection in patients with GCA with aortic aneurysms, (2) to describe the clinical features and outcomes of aortic dissection in patients with GCA, and (3) to determine the average growth rate of aortic aneurysms and identify aneurysm size associated with aortic dissection.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study involved patients with GCA diagnosed at the Mayo Clinic between 2000 and 2012. Data were collected from the records of patients diagnosed with GCA and aortic aneurysms with aneurysm size measured on aortic imaging. Abstracted data included clinical characteristics at diagnosis of aneurysm, aortic aneurysm dimensions at diagnosis and on follow-up imaging, and clinical presentation at the time of dissection or rupture.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA total of 195 patients with GCA and aortic aneurysms were identified, 161 (82%) in the ascending thoracic aorta, 21 (11%) in the descending thoracic aorta, and 13 (7%) in the abdominal aorta. The mean patient age was 74 years, and 62% of patients were women. The overall mean aortic size at diagnosis was 49.3 mm. The average aneurysm overall growth rate was 1.59 mm\/year for the first 3 years after diagnosis. Growth rates at 1, 2, and 3 years from baseline were 2.04, 3.14, and 4.78 mm, respectively (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Average Aneurysm Growth From Baseline\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1279943900\u0022 data-figure-caption=\u0022Average Aneurysm Growth From Baseline\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/14.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14585\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EAverage Aneurysm Growth From Baseline\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from A Makol, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EA total of 14 aortic dissections and 1 rupture were reported, all involving the thoracic aorta. The most common presenting symptoms were chest pain (75%) and syncope (18%). Patients with aortic dissection or rupture had similar characteristics to the baseline cohort. Drugs used at the time of dissection or rupture included glucocorticoids (58%), methotrexate (8%), \u03b2-blockers (83%), aspirin (67%), statins (33%), and angiotensin-converting enzyme inhibitors (50%).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe mean maximal aneurysmal dilation at the time of dissection or rupture was 54\u00b111 mm (range, 41\u201380 mm). The size of the aneurysm at the last follow-up was not predictive of dissection or rupture; intact aneurysms were a mean 50\u00b111 mm (p=0.72). There was no difference in aneurysm size at diagnosis between dissected or ruptured aneurysms (51\u00b110 mm) and those that did not dissect or rupture (49\u00b111 mm) (p=0.47).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EEmergent surgical repair was performed in 8 of 15 patients (57%) with dissection or rupture (88% in the ascending aorta). Medical management was attempted in 7 of 15 (47%), but 4 required surgical intervention. The overall mortality rate at 30 days was 14%.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThere was an 8% incidence of acute aortic syndrome in this cohort of patients with GCA. The data analysis showed that dissection can occur at any size and that aortic size at diagnosis or follow-up did not predict dissection or rupture. This study demonstrated that acute aortic syndrome in patients with GCA has a significant risk for mortality.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/14.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp3e1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp3e1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}