Skip to main content
SpringerLink
Log in

Entzündliche Erkrankungen der Aorta

Inflammatory aortic diseases

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Unter dem Begriff „Aortitis“ werden entzündliche Erkrankungen der Aorta summiert, ein heterogenes Spektrum autoimmun-entzündlicher und infektiöser Erkrankungen. Die Riesenzellarteriitis und die Takayasu-Arteriitis als Vertreter der primären Großgefäßvaskulitiden sind die häufigsten ursächlichen Erkrankungen. Eine weitere wichtige Entität ist die isolierte Aortitis. Mit der IgG4-assoziierten Systemerkrankung muss heute eine weitere Krankheitsentität in diese Gruppe eingeordnet werden. Die klinische Manifestation ist sehr variabel und reicht vom asymptomatischen Zufallsbefund bis zum akuten Aortensyndrom infolge einer Ruptur. Bildgebende Verfahren sind in der Diagnostik von zentraler Bedeutung. Bei Erkrankungen mit häufiger aortaler Beteiligung sollten sie auch zum Screening eingesetzt werden. Die Therapie orientiert sich an der zugrunde liegenden Erkrankung sowie am Ausmaß des bereits eingetretenen aortalen Strukturschadens. Aufgrund der gegensätzlichen Therapiestrategien ist in diesem Zusammenhang die autoimmune von der infektiösen Aortitis abzugrenzen. Die vorliegende Arbeit soll dem Internisten eine praxisrelevante Übersicht über dieses heterogene Krankheitsbild bieten.

Abstract

Inflammatory diseases of the aorta fall under the umbrella term “aortitis” and encompass a broad spectrum of autoimmune and infectious disorders. Giant cell arteritis and Takayasu arteritis represent the most common causative primary large vessel vasculitides. Isolated aortitis is a further important entity, whilst IgG4-associated systemic disease today represents yet another disease entity belonging to this group. Clinical presentation is highly variable, ranging from asymptomatic incidental findings to acute aortic syndrome due to rupture. Diagnostic imaging techniques form the cornerstone of the diagnostic workup. These techniques should also be used in screening for diseases with frequent aortic involvement. The treatment approach depends on the underlying disease and on the extent of aortic damage secondary to vascular inflammation. Against this background, differentiation between autoimmune and infectious aortitis is therefore necessary due to the contrasting treatment strategies. The present article is intended to provide the internist with an overview of this heterogeneous disease entity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Stone JR (2011) Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease. Curr Opin Rheumatol 23:88–94

    Article  PubMed  CAS  Google Scholar 

  2. Gornik HL, Creager MA (2008) Aortitis. Circulation 117:3039–3051

    Article  PubMed  Google Scholar 

  3. Slobodin G, Naschitz JE, Zuckerman E et al (2006) Aortic involvement in rheumatic diseases. Clin Exp Rheumatol 24(2 Suppl 41):41–47

    Google Scholar 

  4. Miller DV, Maleszewski JJ (2011) The pathology of large-vessel vasculitides. Clin Exp Rheumatol 29(1 Suppl 64):92–98

    Google Scholar 

  5. Chung JW, Kim HC, Choi YH et al (2007) Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography. J Vasc Surg 45:906–914

    Google Scholar 

  6. Blockmans D, Ceuninck L de, Vanderschueren S et al (2006) Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 55:131–137

    Article  PubMed  Google Scholar 

  7. Prieto-González S, Arguis P, García-Martínez A et al (2012) Large vessel involvement in biopsy-proven giant cell arteritis: prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis 71:1170–1176

    Article  PubMed  Google Scholar 

  8. Grayson PC, Maksimowicz-McKinnon K, Clark TM et al (2012) Distribution of arterial lesions in Takayasu’s arteritis and giant cell arteritis. Ann Rheum Dis 71:1329–1334

    Article  PubMed  Google Scholar 

  9. Evans JM, O’Fallon WM, Hunder GG (1995) Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis. A population-based study. Ann Intern Med 122:502–507

    Article  PubMed  CAS  Google Scholar 

  10. Mackie SL, Hensor EM, Morgan AW et al (2012) Should I send my patient with previous giant cell arteritis for imaging of the thoracic aorta? A systematic literature review and meta-analysis. Ann Rheum Dis (im Druck)

  11. Kermani TA, Warrington KJ, Crowson CS et al (2012) Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis (im Druck)

  12. Pipitone N, Salvarani C (2011) Idiopathic aortitis: an underrecognized vasculitis. Arthritis Res Ther 13:119

    Article  PubMed  Google Scholar 

  13. Schmidt J, Sunesen K, Kornum JB et al (2011) Predictors for pathologically confirmed aortitis after resection of the ascending aorta: a 12-year Danish nationwide population-based cross-sectional study. Arthritis Res Ther 13:R87

    Article  PubMed  Google Scholar 

  14. Tang T, Boyle JR, Dixon AK et al (2005) Inflammatory abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 29:353–362

    Article  PubMed  CAS  Google Scholar 

  15. Pipitone N, Salvarani C, Peter HH (2010) Chronische Periaortitis. Internist 51:45–52

    Article  PubMed  CAS  Google Scholar 

  16. Palazzi C, Salvarani C, D’Angelo S et al (2011) Aortitis and periaortitis in ankylosing spondylitis. Joint Bone Spine 78:451–455

    Article  PubMed  Google Scholar 

  17. Roldan CA, Chavez J, Wiest PW et al (1998) Aortic root disease and valve disease associated with ankylosing spondylitis. J Am Coll Cardiol 32:1397–1404

    Google Scholar 

  18. Mäki-Petäjä KM, Elkhawad M, Cheriyan J et al (2012) Anti-tumor necrosis factor-α therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis. Circulation 126:2473–2480

    Article  PubMed  Google Scholar 

  19. Lopes RJ, Almeida J, Dias PJ et al (2009) Infectious thoracic aortitis: a literature review. Clin Cardiol 32:488–490

    Article  PubMed  CAS  Google Scholar 

  20. Mussa FF, Hedayati N, Zhou W et al (2007) Prevention and treatment of aortic graft infection. Expert Rev Anti Infect Ther 5:305–315

    Article  PubMed  Google Scholar 

  21. Czihal M, Zanker S, Rademacher A et al (2012) Sonographic and clinical pattern of extracranial and cranial giant cell arteritis. Scand J Rheumatol 41:231–622

    Article  PubMed  CAS  Google Scholar 

  22. Czihal M, Tatò F, Förster S et al (2010) Fever of unknown origin as initial manifestation of large vessel giant cell arteritis: diagnosis by colour-coded sonography and 18-FDG-PET. Clin Exp Rheumatol 28:549–552

    PubMed  CAS  Google Scholar 

  23. Stone JH, Zen Y, Deshpande V (2012) IgG4-related disease. N Engl J Med 366:539–551

    Google Scholar 

  24. Czihal M, Förster S, Hoffmann U (2010) Bildgebende Diagnostik der Großgefäßvaskulitiden. Radiologe 50:855–860

    Article  PubMed  CAS  Google Scholar 

  25. Partovi S, Imfeld S, Aschwanden M et al (2012) The use of contrast-enhanced ultrasound (CEUS) in chronic periaortitis. Ultraschall Med (im Druck)

  26. Dasgupta B, Borg FA, Hassan N et al (2010) BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford) 49:1594–1597

    Google Scholar 

  27. Buhaescu I, Yood RA, Izzedine H (2010) Serum procalcitonin in systemic autoimmune diseases – where are we now? Semin Arthritis Rheum 40:176–183

    Article  PubMed  CAS  Google Scholar 

  28. Espitia O, Néel A, Leux C et al (2012) Giant cell arteritis with or without aortitis at diagnosis. A retrospective study of 22 patients with longterm followup. J Rheumatol 39:2157–2162

    Google Scholar 

  29. Bommel EF van, Veer SJ van der, Hendriksz TR et al (2008) Persistent chronic peri-aortitis (‚inflammatory aneurysm‘) after abdominal aortic aneurysm repair: systematic review of the literature. Vasc Med 13:293–303

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Sektion Angiologie – Gefäßzentrum, Medizinische Klinik und Poliklinik IV, Klinikum der LMU, Pettenkoferstr. 8a, 80336, München, Deutschland

    M. Czihal, A. Schröttle &  U. Hoffmann

  2. Rheumaeinheit, Medizinische Klinik und Poliklinik IV, Klinikum der LMU, München, Deutschland

    H. Schulze-Koops

Authors
  1. M. Czihal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Schröttle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Schulze-Koops
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Hoffmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Czihal, M., Schröttle, A., Schulze-Koops, H. et al. Entzündliche Erkrankungen der Aorta. Internist 54, 572–580 (2013). https://doi.org/10.1007/s00108-012-3222-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3222-3

Schlüsselwörter

Keywords

Search

Navigation