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Related Concept Videos

Aneurysm I: Introduction01:30

Aneurysm I: Introduction

An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
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Aortic aneurysm due to microscopic polyangiitis.

Masaaki Ryomoto1, Masataka Mitsuno, Hiroyuki Nishi

  • 1Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.

The Annals of Thoracic Surgery
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Summary

Microscopic polyangiitis, a condition usually affecting small vessels, rarely causes aortic aneurysms. This case highlights a unique instance of ascending aortic aneurysm in a patient with this autoimmune vasculitis.

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Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Immunology

Background:

  • Microscopic polyangiitis (MPA) is a rare systemic vasculitis typically affecting small-caliber vessels.
  • Aortic aneurysms are an uncommon manifestation of MPA, posing diagnostic and therapeutic challenges.

Observation:

  • A 36-year-old woman with a 10-year history of MPA, treated with oral hydrocortisone, presented with an ascending aortic aneurysm and severe aortic insufficiency.
  • The aneurysm occurred without dilatation of the aortic root (sinus of Valsalva).
  • High titers of serum perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) were detected.

Findings:

  • Surgical replacement of the ascending aorta and aortic valve was performed.
  • Pathologic examination of the resected aorta revealed significant adventitial and intimal thickening.
  • The aortic media showed severe destruction and atrophy, indicative of inflammatory damage.

Implications:

  • This case represents the first reported surgical instance of an aortic aneurysm associated with microscopic polyangiitis.
  • It underscores the potential for MPA to affect large vessels, including the aorta.
  • Further research is warranted to understand the pathogenesis and optimal management of MPA-associated aortic aneurysms.