Aortitis Follow-up

Updated: Dec 18, 2014
  • Author: Masato Okada, MD, FACP, FACR, FAAAAI; Chief Editor: Uchechukwu Sampson, MBBS, MPH, MBA, MSc  more...
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Follow-up

Further Outpatient Care

Monitor periodically for complications and for progression of the inflammatory processes. Clinical evaluation with careful history review for any new or progressive signs is vital. Periodic examinations should include funduscopic examination, checking pulses and pressures in all limbs, checking for bruits and signs of abdominal aneurysm, and neurologic examination. No particular blood test has proven reliable, but a variety may be useful if they happen to indicate increased activation.

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Further Inpatient Care

Further care includes the following:

  • Catheterization to assess systemic and pulmonary hypertension, coronary and renal artery disease, and other specific sites of suspected obstruction
  • Arterial wall biopsy
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Deterrence/Prevention

Aortic trauma with dissection, transplants, immune disorders including connective tissue diseases and inflammatory bowel diseases, infections, and medications that may induce immune complex disease should all raise suspicion for subsequent vasculitis. Vague constitutional symptoms, neck pain, or headaches likewise should raise suspicion for early diagnosis.

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Complications

Complications include aortic insufficiency, angina pectoris, myocardial infarction, stroke, limb ischemia, renal artery hypertension, and all consequences of vascular disease.

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Prognosis

Overall, 10-year survival rate has been reported as 80-90%. Two major predictors of outcome are incidence of complications (eg, Takayasu retinopathy, hypertension, aortic regurgitation, aneurysm) and a progressive course.

Patients with no complications or with mild to moderately severe complications had a 10-year survival rate of 100% and a 15-year survival rate of 93-96%. Complications or progression reduces the 15-year survival rate to 66-68%.

The presence of both a major complication and progressive course nets a 43% survival rate at 15 years.

Cases that are diagnosed late may enter a fulminant course leading quickly to death unless very aggressive immunotherapy is instigated promptly.

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