Treatment of aortitis is inextricably linked with active therapy of the underlying disease. In infectious aortitis, antibiotics serve as first-line drugs; with allergic aortitis – glucocorticoids, NSAIDs, immunosuppressants; with syphilitic aortitis – preparations of bismuth, iodine, penicillin antibiotics. The effectiveness of therapy is monitored by the dynamics of clinical and laboratory parameters.
The presence of an aortic aneurysm, especially signs of its dissection, is the basis for consultation of a vascular surgeon and angiosurgical treatment – resection of the aneurysm, followed by prosthetic aorta. With the development of aortic stenosis, balloon dilatation, stenting or shunting may be required.
Aortitis – vasculitis, a special case of aortoarteritis with exceptional or preferential aortic damage. Due to the variety of reasons leading to the development of aortitis, the disease is not only in the field of view of cardiology, but also rheumatology, venereology, allergology, pulmonology and phthisiology, traumatology.
Usually, the aorta affects the thoracic aorta, less often the abdominal aorta. If the inflammation captures the individual layers of the aorta, they talk about endauritis, mesaortitis, periaortitis; with the defeat of the entire thickness of the arterial wall (intima, media and adventitia) – about panaortitis. The distribution of aortitis can be ascending, descending and diffuse.
Aortitis is an inflammatory process that engages individual layers or the entire thickness of the aortic wall. Depending on the etiology and localization of the lesion, aortitis may be manifested by the development of aortalgia, abdominal toad, renovascular hypertension, limb ischemia; chills, fever, dizzy spells and fainting. Aortitis is diagnosed on the basis of laboratory (biochemical, immunological) and instrumental studies (aortography, USDG, CT). Treatment of aortitis primarily involves the treatment of the underlying disease (infectious, allergic, autoimmune damage).
Causes of aortitis
Depending on the etiology, there are 2 groups of aortitis: infectious and allergic.
The development of infectious aortitis associated with the penetration of the infectious pathogen into the aortic wall by hematogenous or lymphogenous or the spread of the inflammatory process on the aorta from the adjacent tissues.
Specific infectious aortitis most often develops with syphilis, tuberculosis, less often with brucellosis. Nonspecific aortitis is usually bacterial in nature and is usually associated with a previous streptococcal infection and rheumatic fever.
The aorta may be involved in inflammation in lung abscess, mediastinitis, infective endocarditis.
Allergic aortitis is most often caused by autoimmune diseases, collagenoses, systemic vasculitis (Takayasu disease). Cases of aortitis with ankylosing spondylitis (ankylosing spondylitis), rheumatoid arthritis, and thromboangiitis obliterans are described. Aortitis may be an integral part of Cogan syndrome, also characterized by inflammatory keratitis, vestibular and auditory dysfunction.
Classification and pathogenesis of aortitis
Given the prevalence of certain pathological processes, there are purulent, necrotic, productive, granulomatous forms of aortitis. Purulent and necrotic aortitis have an acute or subacute course, the rest are chronic. Pathological changes in the arterial wall have their differences with aortitis of various etiologies.
With aortic syphilitic nature, the intimal aortic layer undergoes inflammatory and sclerotic processes, as a result of which it becomes wrinkled, scar-modified, with coarse folds resembling the bark of a tree. The mouth of the coronary arteries, as well as the semilunar valves of the aorta valve, are involved in the pathological process, contributing to the occurrence of aortic insufficiency. In the late period of syphilitic aortitis, sacciform or diffuse aortic aneurysms are formed. Syphilitic gum are sometimes found in the wall of the aorta.
Tuberculous aortitis develops with a corresponding lesion of the lymph nodes, lungs, mediastinal organs, retroperitoneal space. Specific granulations and foci of caseous necrosis are formed in the vascular wall. For tuberculous aortitis is characterized by the presence of ulceration of the endothelium, aneurysm, calcification of the aortic wall, and perforations.
Rheumatic aortic affection proceeds as panaortitis. In this case, mucoid edema, fibrinoid swelling with subsequent granulomatosis and sclerosis develop in all layers of the aorta. Purulent aortitis is accompanied by phlegmonous or abscess inflammation of the aortic wall, its dissection and perforation. Typically, inflammation passes to the aortic wall from adjacent organs, surrounding tissue or due to septic thrombosis.
Ulcerative-necrotic aortitis is usually the result of bacterial endocarditis, sepsis, and less commonly, complications of operations on the aortic valve or open arterial duct. At the same time, vegetations, thrombotic masses, areas of ulceration, dissection and perforation of the aortic wall are detected in the aortic endothelium. Nonspecific aortoarteritis (Takayasu’s disease) proceeds according to the type of productive inflammation with overproduction of fibrous tissue.
Symptoms of aortitis
The clinical picture of aortitis is unfolding against the background of symptoms of the underlying disease (syphilis, rheumatism, tuberculosis, infective endocarditis, sepsis, etc.).
Actually, aortitis is mainly manifested by signs of ischemia of organs that receive blood supply through the main branches of the aorta. So, cerebral ischemia is accompanied by dizziness, headaches, visual impairment, fainting; ischemia of the heart muscle – angina, myocardial infarction (often painless); renal ischemia – arterial hypertension; intestinal ischemia – attacks of abdominal toad.
The characteristic sign of aortitis is aortalgia – pain along the affected aorta, associated with the involvement of para-aortic nerve plexuses. The defeat of the thoracic aorta is accompanied by pressing or burning pains in the chest, which can shift into the neck, both hands, between the shoulder blades, the epigastric region. Tachycardia, shortness of breath, whooping cough-like cough may occur, the causes of which are unclear. In case of affection of the abdominal aorta, the pain is localized in the abdomen or lower back. The pain syndrome in aortitis is expressed almost constantly, the intensity of pain periodically changes.
An early pathognomonic sign of aortitis is pulse asymmetry on the radial, subclavian, and carotid arteries or its complete absence on one side. When measuring blood pressure on one hand, it can be significantly reduced or not be determined at all.
Complications of aortitis can be thromboembolism, bacterial emboli, dissecting aortic aneurysm, aortic rupture. Manifestations of syphilitic aortitis usually develop 15-20 years after infection. Syphilitic aortitis is almost asymptomatic until the development of complications (aortic insufficiency, cardiosclerosis, heart failure).
Diagnosis of aortitis
To determine the causes of aortic lesions, patients with suspected aortitis should be consulted by a venereologist, rheumatologist, tuberculosis specialist, and cardiologist. To substantiate the diagnosis of aortitis it is necessary to study the clinical, laboratory and instrumental data.
If rheumatic aortitis is suspected, C-reactive protein, blood immunoglobulins, antinuclear antibodies, circulating immunocomplexes, etc. are examined. Serological blood tests (RPR test) or cerebrospinal fluid are needed to confirm syphilitic aortitis.
In tuberculous aortitis, a sputum test on the VC is shown by PCR, a full X-ray examination (chest X-ray, tomography). Diagnosis of bacterial aortitis requires blood culture for sterility.
The data obtained are refined using USDG, aortography, CT or aortic MSCT. The differential diagnosis of aortitis is performed with aortic atherosclerosis, ischemic heart disease.
Prognosis and prevention
The severity of the prognosis for aortitis is determined by its shape and etiology. The most serious prognosis for acute and subacute bacterial aortitis. The course of syphilitic and tuberculous aortitis is the more favorable the earlier the specific treatment is started.
The development of other forms of chronic aortitis largely depends on the underlying disease. If untreated, the disease is prone to progression and complicated course.
For the prevention of aortitis, timely treatment of primary diseases, prevention of STDs, active detection of tuberculosis are of paramount importance.