Multidisciplinary diagnosis and management of inflammatory aortic aneurysms

Xu, Jun; Bettendorf, Brittany; D’Oria, Mario; Sharafuddin, Mel J.

doi:10.1016/j.jvs.2022.12.024

Cited by 7 publications

(3 citation statements)

References 136 publications

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“…For this reason, IgG4 is considered to play an anti-inflammatory role in various disorders, but it may accelerate vascular structural injury when acting on the blood vessels. 17 Despite that, the etiology of IgG4-related vasculitis is still unclear. Patients with IgG4-RD have a high tendency to develop IgG4-related large vessel vasculitis, which can involve the thoracic aorta, abdominal aorta, mesenteric artery, and splenic artery, 18 , 19 as well as the major branches of the aorta and other blood vessels.…”

Section: Discussionmentioning

confidence: 99%

IgG4-Related Disease Manifested as Cutaneous Plasmacytosis: A Case Report

Wang,

Kang,

Ding

et al. 2023

CCID

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Background IgG4-related disease (IgG4-RD) is a rare fibroinflammatory disease that has a high tendency to misdiagnosis in clinics. Case Presentation A 48-year-old man developed a rash with progressive itching 3 years ago after hormone therapy for an ocular “inflammatory pseudotumor”. The disease condition of this patient involved multiple organs which involved the skin. The patient was misdiagnosed with other diseases during the period of hospitalization, leading to poor therapeutic effects and repeated skin lesions. The dermatopathological report indicated plasma cell proliferative disorder, with IgG4/IgG exceeding 40% and abnormally elevated serum IgG4 levels. After the patient was diagnosed with IgG4-RD, a series of treatments improved skin lesions, relieved other symptoms, and decreased serum IgG4 levels. Conclusion IgG4-RD is a highly misdiagnosed disease that deserves the attention of physicians. The patient we reported could be considered a representative case of IgG4-RD that presents with skin lesions. For patients with suspected IgG4-RD, serum IgG4 testing should be performed, and further imaging, serological tests, and pathology examinations are needed to exclude malignancy, infection, and autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

IgG4-Related Disease Manifested as Cutaneous Plasmacytosis: A Case Report

Wang,

Kang,

Ding

et al. 2023

CCID

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“…These may include the patient's medical history, medications, allergies, and any other medical conditions that may affect the patient's response to anaesthesia. Tanaka et al [50] investigated the anesthetic management of an abdominal aortic aneurysmorrhaphy in Klippel-Trenaunay-Weber syndrome. They described that the secure anaesthesia care should be provided to a patient with Klippel-Trenaunay-Weber syndrome who experienced an abdominal aortic aneurysm surgery.…”

Section: Discussionmentioning

confidence: 99%

Optimising anesthesia support during operations on the abdominal aorta and its branches

2022

FEM

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Background: Pathology of the aorta includes aortic aneurysms, coarctation, dissection, atherosclerotic disease, and aortitis. The only two evidence-based treatment options for abdominal aortic repair are endovascular and open surgery. The anesthetic approach and medications may impact the outcomes of the surgical repair of the abdominal aorta and its branches. Aim: to evaluate the use of various analgesic regimens and local, regional, or general anesthesia in "optimising" surgical outcomes in patients undergoing surgical repair of the abdominal aorta and its branches. Methods: In this review, English studies from common databases such as Pubmed/MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane Library with the keywords "Abdominal aorta," "operations," "aortic branches," combined with keywords, involving " anesthesia were involved." The end date for this review was November 2022. Scientific novelty: Recent scientific studies have focused on the use of advanced monitoring technologies such as cerebral oximetry and microdialysis to improve the safety and efficacy of anesthesia management in aortic surgery. These technologies provide more accurate and real-time information about cerebral perfusion and metabolism, allowing the anesthesiologist to identify and manage potential complications such as cerebral ischemia more effectively. Additionally, the use of pharmacological agents such as dexmedetomidine and remifentanil has been shown to reduce the risk of postoperative delirium and cognitive dysfunction, further improving patient outcomes. Conclusion: Aortic surgery is a complex and high-risk procedure that requires careful management of anesthesia to ensure patient safety and optimal outcomes. With ongoing advances in anesthesia techniques and monitoring technologies, there is reason to be optimistic about the future of aortic surgery and the prospects for improved patient outcomes. The anesthesiologist plays a critical role in this process, working closely with the surgical team to provide safe and effective anesthesia throughout the procedure and ensuring that the patient receives appropriate pain management and other supportive care in the postoperative period

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“…CP as a whole has an unclear etiology, some have speculated that extended response to atherosclerosis might be the case, although concerning IRF, it also occurs without atherosclerosis [4]. More recently, IgG4-related disease (IgG4-RD), has been linked to iAAA, being present in up to 57% of iAAA cases [5], having prompted some to classify Diagnostics 2023, 13, 1669 2 of 10 iAAA as either IgG4-iAAA or non-IgG4-iAAA [6]. However, its pathophysiology remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound for the Detection of Inflammatory Abdominal Aortic Aneurysms: A Case and Validation Series

Slijkhuis,

Liesker,

Konter

et al. 2023

Diagnostics

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Inflammatory abdominal aortic aneurysms (iAAA) are a form of noninfectious aortitis in patients with abdominal aortic aneurysms (AAA). Ultrasound could help to detect iAAA early. This retrospective observational study assessed the potential of using ultrasound to detect iAAA in a case series of iAAA patients, and the diagnostic value of ultrasound to detect iAAA in consecutive patients in a follow-up for AAA, referred to as a feasibility study. In both studies, diagnosis of iAAA was based on a cuff surrounding the aneurysm using CT (golden standard). The case series included 13 patients (age 64 (61; 72) years; 100% male). The feasibility study included 157 patients (age 75 (67; 80) years; 84% male). In the case series, all iAAA patients showed a cuff surrounding the aortic wall on ultrasound. In the feasibility study with AAA patients, ultrasound yielded no cuff in 147 (93.6%; CT negative in all cases), a typic cuff in 8 (5.1%; CT positive in all cases), and an inconclusive cuff in 2 (1.3%; CT negative in both cases) patients. Sensitivity and specificity were 100% and 98.7%, respectively. This study indicates that iAAA can be identified with ultrasound, and safely ruled out. In positive ultrasound cases, additional CT imaging might still be warranted.

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Multidisciplinary diagnosis and management of inflammatory aortic aneurysms

Cited by 7 publications

References 136 publications

IgG4-Related Disease Manifested as Cutaneous Plasmacytosis: A Case Report

IgG4-Related Disease Manifested as Cutaneous Plasmacytosis: A Case Report

Optimising anesthesia support during operations on the abdominal aorta and its branches

Ultrasound for the Detection of Inflammatory Abdominal Aortic Aneurysms: A Case and Validation Series

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