Aortic and extracranial large vessel giant cell arteritis: A review of 72 cases with histopathologic documentation

Giant cell arteritis (GCA) is closely identified with the temporal arteritis-polymyalgiarheumatica syndrome of the elderly. It is also a systemic disease that can cripple and kill. Up to 15% of patients with temporal arteritis may have angiographic evidence of extracranial GCA, and aortic insufficie...

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Bibliographic Details
Published in:Seminars in arthritis and rheumatism 1995-06, Vol.24 (6), p.422-431
Main Author: Lie, J.T.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aneurysm, Dissecting - etiology
Aneurysm, Dissecting - mortality
Aortic Aneurysm - etiology
Aortic Aneurysm - mortality
Aortic Diseases - diagnostic imaging
Aortic Diseases - pathology
Biological and medical sciences
Female
Femoral Artery
Giant Cell Arteritis - complications
Giant Cell Arteritis - diagnostic imaging
Giant Cell Arteritis - pathology
Humans
Male
Medical sciences
Middle Aged
Popliteal Artery
Radiography
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Subclavian Artery
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Summary:Giant cell arteritis (GCA) is closely identified with the temporal arteritis-polymyalgiarheumatica syndrome of the elderly. It is also a systemic disease that can cripple and kill. Up to 15% of patients with temporal arteritis may have angiographic evidence of extracranial GCA, and aortic insufficiency, ruptured aortic aneurysm, aortic dissection, stroke, or myocardial infarction may be the initial manifestation of systemic GCA. A review of 72 cases of aortic and extracranial GCA, all with histopathologic verification of the disease, revealed that 25% of patients with aortic and extracranial large-vessel GCA had asymptomatic temporal arteritis; the ascending aorta and aortic arch were most frequently involved (39%), followed by the subclavian and axillary arteries (26%), and the femoropopliteal arteries (18%). Nine patients (12.5%) underwent an upper or lower limb amputation. Of the 18 patients whose death was directly attributable to extracranial GCA the causes were ruptured aortic aneurysm (6), aortic dissection (6), stroke (3), and myocardial infarction (3). The findings of these 72 cases caution against attributing all aortic and large-vessel arterial disease in the elderly to atherosclerosis and emphasize that timely surgical intervention may be necessary for life-saving and limb-salvage in patients with aortic and extracranial GCA.
ISSN:0049-0172
1532-866X
DOI:10.1016/S0049-0172(95)80010-7