Clinical and Angiographic Features of Nonspecific Aorto-Arteritis in Children and Adults

Abstract

We compared clinical and angiographic features of nonspecific aorto-arteritis in children with those of adult patients. Digital subtraction angiography by i.v. and/or i.a. injection was carried out in 104 patients. In group 1, consisting of 32 patients aged 16 years and younger, hypertension (75%) was the most common clinical feature, followed by diminished pulse, bruit (72% each), congestive cardiac failure (38%), and limb claudication (1 3%). Obstructing arterial lesions were always present and commonly involved the abdominal aorta (75'%), descending thoracic aorta (41%), renal (63%)) and subclavian (41%) arteries. In Group 2, consisting of 72 patients more than 16 years of age, arterial bruit (91%), and diminished pulse (82%) were the most common symptoms. Hypertension occurred in 61%, congestive failure in 14%, and limb claudication in 30'%. Obstructing lesions were always seen and commonly involved the abdominal aorta (77%) and renal arteries (64%). Involvement of the descending thoracic aorta (26%) was less common but subclavian (57%) and carotid (24%)) arteries were more commonly involved than in group I. Arterial aneurysms and pulmonary involvement were uncommon in both groups. There were some clinical and angiographic differences in nonspecific aorto-arteritis between children and adults but these were statistically insignificant (chisquare test).

Non-specific aortoarteritis (NSAA) in children: a prospective observational study

“…There are usually no intercostal collaterals due to the involvement of ostia of these intercostal arteries. Similarly, aneurysms do occur but rarely without stenotic lesions, 26 27 and in our cohort, only one child had an aneurysm. AR has been reported in 7%–15% patients of NSAA 22 24 30 while in our cohort, the incidence was 21% (6 patients).…”

“…The classical features of NSAA like constitutional symptoms, unequal pulses, significant BP difference between two arms and carotidynia are less commonly described in childhood NSAA. 26 27 The reason for this observed difference in the presentation of NSAA in children and adults is that the most frequently involved major branch in childhood NSAA is renal artery rather than SCA as demonstrated in our cohort also. In addition, children often present with BP difference between UL and LL rather than between two ULs, as the descending aorta is the most common part of the aorta involved.…”

CSI position statement on management of heart failure in India

“…Angiographic manifestations is very heterogeneous in different geographical areas with predilection for stenotic versus dilative and thoracic versus abdominal aortic involvement in different geographic locations 325, 326, 327, 328, 329, 330…”

“…Dyspnea was present in (20%) of the cases. Absent or diminished pulses were present in 80–82%, hypertension in 61 − 75%, congestive cardiac failure in 8–38% and claudication in 13–74% of the cases 329, 330, 331, 332…”