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Clinical characteristics and outcomes of aortic arch emergencies : takayasu disease, fibromuscular dysplasia, and aortic arch pathologies : a retrospective study and review of the literature
aortic arch pathology
aortic dissection
arteritis
connective tissue disorders
fibromuscular dysplasia
percutaneous intervention
rare cardiovascular disease
stenosis of aortic arch
Takayasu disease
Non-atherosclerotic aortic arch pathologies (NA-AAPs) and anatomical variants are characterized as rare cardiovascular diseases with a low incidence rate, below 1 case per 2000 population, but enormous heterogeneity in terms of anatomical variants, i.e., Takayasu disease (TAK) and fibromuscular dysplasia (FMD). In specific clinical scenarios, NA-AAPs constitute life-threatening disorders. Methods: In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. Results: The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11–1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59–0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74–9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. Conclusions: This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients.
cris.lastimport.wos | 2024-04-10T02:03:29Z | |
dc.abstract.en | Non-atherosclerotic aortic arch pathologies (NA-AAPs) and anatomical variants are characterized as rare cardiovascular diseases with a low incidence rate, below 1 case per 2000 population, but enormous heterogeneity in terms of anatomical variants, i.e., Takayasu disease (TAK) and fibromuscular dysplasia (FMD). In specific clinical scenarios, NA-AAPs constitute life-threatening disorders. Methods: In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. Results: The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11–1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59–0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74–9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. Conclusions: This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients. | |
dc.affiliation | Wydział Lekarski : Instytut Kardiologii | pl |
dc.cm.date | 2023-08-07T22:16:20Z | |
dc.cm.id | 112878 | pl |
dc.cm.idOmega | UJCM8dc5e2da2c7e4baeb7cf951b3e843730 | pl |
dc.contributor.author | Wawak, Magdalena | pl |
dc.contributor.author | Tekieli, Łukasz | pl |
dc.contributor.author | Badacz, Rafał - 148377 | pl |
dc.contributor.author | Odrowąż-Pieniążek, Piotr - 133022 | pl |
dc.contributor.author | Maciejewski, Damian | pl |
dc.contributor.author | Trystuła, Mariusz - 356558 | pl |
dc.contributor.author | Przewłocki, Tadeusz - 133225 | pl |
dc.contributor.author | Kabłak-Ziembicka, Anna - 129937 | pl |
dc.date.accession | 2023-08-07 | pl |
dc.date.accessioned | 2023-08-07T22:16:20Z | |
dc.date.available | 2023-08-07T22:16:20Z | |
dc.date.issued | 2023 | pl |
dc.date.openaccess | 0 | |
dc.description.accesstime | w momencie opublikowania | |
dc.description.number | 8 | pl |
dc.description.version | ostateczna wersja wydawcy | |
dc.description.volume | 11 | pl |
dc.identifier.articleid | 2207 | pl |
dc.identifier.doi | 10.3390/biomedicines11082207 | pl |
dc.identifier.eissn | 2227-9059 | pl |
dc.identifier.issn | 2227-9059 | pl |
dc.identifier.uri | https://ruj.uj.edu.pl/xmlui/handle/item/317568 | |
dc.identifier.weblink | https://www.mdpi.com/2227-9059/11/8/2207 | pl |
dc.language | eng | pl |
dc.pbn.affiliation | Dziedzina nauk medycznych i nauk o zdrowiu : nauki medyczne | |
dc.rights | Udzielam licencji. Uznanie autorstwa 4.0 Międzynarodowa | |
dc.rights.licence | CC-BY | |
dc.rights.simpleview | Wolny dostęp | |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/legalcode.pl | |
dc.share.type | Otwarte czasopismo | |
dc.subject.en | aortic arch pathology | |
dc.subject.en | aortic dissection | |
dc.subject.en | arteritis | |
dc.subject.en | connective tissue disorders | |
dc.subject.en | fibromuscular dysplasia | |
dc.subject.en | percutaneous intervention | |
dc.subject.en | rare cardiovascular disease | |
dc.subject.en | stenosis of aortic arch | |
dc.subject.en | Takayasu disease | |
dc.subtype | Article | pl |
dc.title | Clinical characteristics and outcomes of aortic arch emergencies : takayasu disease, fibromuscular dysplasia, and aortic arch pathologies : a retrospective study and review of the literature | pl |
dc.title.journal | Biomedicines | pl |
dc.type | JournalArticle | pl |
dspace.entity.type | Publication |
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