Aortic Pathology in Systemic Lupus Erythematosus: A Case Report and Review of Literature

Silvestri, Valeria; Simonte, Gioele

doi:10.1016/j.avsg.2017.01.022

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…An increased relative risk has also been reported for aortic dissection, with older age, male sex, SLE duration of > 3 years, and hypertension reported as risk factors for both aortic aneurysm and dissection [7]. In terms of pathological ndings, histological ndings of diffuse aortitis are noted in cases of aortic dissection in patients with SLE, and medial cystic changes and loss of elastic bers are recognized as the primary lesions [18,19]. In the present case, we believe that SLE had little effect on the patient because the in ammatory response was negative and stable after 1 year of steroid treatment after the diagnosis of SLE.…”

Section: Resultsmentioning

confidence: 99%

Pseudoaneurysm With A Fistula To The Right Ventricle Late After Surgical Repair of Type A Aortic Dissection in A Patient with Systemic Lupus Erythematosus: A Case Report

Shimada

Yamamoto

Endo

et al. 2021

Preprint

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Background: Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical treatment is unavoidable, but surgery is complicated, and there are some pitfalls. Herein, we explain the reoperation procedure performed for a patient at high surgical risk by clarifying the shunt site using multi-modality imaging before surgery.Case presentation: A 69-year-old woman with a history of systemic lupus erythematosus (SLE) and Sjogren’s syndrome presented with a pseudoaneurysm 1 year after emergency surgery for acute type A aortic dissection. Eight years after the first operation, she experienced sudden chest pain and presented to the emergency department. Her dyspnea also worsened; therefore, echocardiography and three-dimensional computed tomography (3DCT) were performed, which revealed a pseudoaneurysm and a shunt to the right ventricle. The medical team attempted to close the shunt with a percutaneous catheter but was unsuccessful, and she was referred to our department for surgical treatment.The pseudoaneurysm originating from the proximal side of the aorta was large with a diameter of 55 mm, and echocardiography-gated 3DCT visualized the shunt from the pseudoaneurysm to the right ventricle. First, extracorporeal circulation was initiated, and a re-sternotomy was performed. We could not insert the left ventricular venting tube from the right side because of the size of the pseudoaneurysm; instead, the tube was inserted from the left atrial appendage. We found a half-circumferential disengaged anastomosis around the proximal anastomosis, which formed the large pseudoaneurysm leading to a fistula in the right ventricle. We closed the fistula and performed a Bentall operation.The patient had a good postoperative course and was discharged on postoperative day 21. She continued treatment for SLE and Sjogren’s syndrome and her inflammatory reaction improved.Conclusion: We performed a Bentall operation and closure of a fistula with a re-sternotomy in a patient with type A aortic dissection with systemic lupus erythematosus and Sjogren’s syndrome. Multimodal imaging is essential in defining the pseudoaneurysm and the fistula surrounding the anatomy while ensuring their resolution and guiding the approach for operation.

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Section: Resultsmentioning

confidence: 99%

Pseudoaneurysm With A Fistula To The Right Ventricle Late After Surgical Repair of Type A Aortic Dissection in A Patient with Systemic Lupus Erythematosus: A Case Report

Shimada

Yamamoto

Endo

et al. 2021

Preprint

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“…This hypothesis becomes more interesting as the authors add considerations on the complications occurring at distal anastomotic site of the aortic repair performed through aortic synthetic graft implant in their patient: as occurs in aortic conditions related to other infectious or autoimmune disease [ 9 , 27 ], the authors have observed the occurrence of bleeding in the suture line (usually due to aortic wall loss of elastic structure and strength). These complications may be frequent in inflammatory aortopathy in its acute phase, which may later evolve, in a chronic phase, to formation of aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, free rupture of the para-renal abdominal aorta, above a previous abdominal aortic endo-graft implanted for aneurysm in an 80 years old patient, was reported by Rinaldi et. Even though the timing of proximal aortic aneurysm formation can't be determined, recurrent complicated aortic pathology has previously been described in patients with inflammatory conditions, such as autoimmune disease, due to histological changes leading to weakening of aortic wall [27] .…”

Section: Discussionmentioning

confidence: 99%

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Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions

Silvestri

Recchia

2021

Annals of Vascular Surgery

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Introduction Cardiovascular involvement in SARS-CoV-2 infection has emerged as one of viral major clinical features during actual pandemic; limb arterial ischemic events, venous thrombosis, acute myocardial infection and stroke have occurred in patients. Acute aortic conditions have also been described, followed by interesting observations on cases, hypothesis, raised since the emergence of the pandemics. Methods a review of cases in literature of aortic pathology in patients with clinically suspected/microbiologically confirmed COVID-19 infection has been carried out to analyze anagraphic data, clinical presentation, treatment options and outcome. Results 17 cases have been included. Mean age of patients was 58.6±15.2years, with a male to female ratio of 12:15 (70.5% vs 29.5%). Comorbidities were reported in 11 cases (64.7%), but in 5 cases (29.4%) no previous pathology was signaled in history. Hypertension was the most frequently reported comorbidity, in 8 cases, (47%), followed by renal pathology (17.6%), coronary artery disease (17.6%), previous aortic surgery (11.7%) and arrhythmia (11.7%); but also cerebrovascular disease, diabetes, autoimmune conditions, previous neoplasia and arrhythmia were reported once each. Fever and thoracic pain were the most frequently reported findings at presentation (8 cases, 47% each), followed by respiratory symptoms (6, 35.2%), low lymphocyte count (17.6%), features related to aneurysm rupture, ischemic stroke, abdominal pain and acute renal insufficiency. Reported aortic pathology included: type A aortic dissection (11 cases; 64.7%); new pathology of previous aortic graft (2 cases, 11.7%); 2 aortitis, one associated with type A aortic dissection; 1 thoraco-abdominal aortic aneurysm, 1 ruptured aortic aneurysm and 1 aortic embolizing thrombosis. Open surgery was carried out in 10 cases (58.8%), endovascular treatment in 3 (17.6%). Three patients (17.6%) died before surgery. Exitus was reported in 4 cases, with a total mortality of 23.5%. Conclusions Acute aortic events have occurred during pandemic in patients with clinically suspected/microbiologically confirmed COVID-19 infection. Confounding clinical features at presentation, the importance of anamnestic details (as previous vascular graft implant), the observed surgical and post-operatory challenges may suggest the need to consider the implications of the possible link between acute aortic events and SARS-CoV-2 infection, in order to promptly correctly diagnose the patient and respond to specific needs.

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“…Typical AAA is an advanced atherosclerotic disease that is common in adults more than 65 years old and is induced by thinning of the media and adventitia in the vasculature due to smooth muscle cell loss [ 16 17 ]. However, AAA in younger patients is thought to be caused by proinflammatory cytokines, dysregulation of the immune system, genetics, or rheumatic disease, rather than degenerative changes from aging [ 16 17 24 25 ]. We hypothesized that differences in underlying disease could affect vulnerability to depression in younger patients with AAA.…”

Section: Discussionmentioning

confidence: 99%

Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study

et al. 2021

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Aortic Pathology in Systemic Lupus Erythematosus: A Case Report and Review of Literature

Cited by 16 publications

References 23 publications

Pseudoaneurysm With A Fistula To The Right Ventricle Late After Surgical Repair of Type A Aortic Dissection in A Patient with Systemic Lupus Erythematosus: A Case Report

Pseudoaneurysm With A Fistula To The Right Ventricle Late After Surgical Repair of Type A Aortic Dissection in A Patient with Systemic Lupus Erythematosus: A Case Report

Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions

Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study

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