The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
J Am Coll Cardiol. 2022 Aug 23;80(8):832-844. doi: 10.1016/j.jacc.2022.05.046.
Inflammatory aortitis is most often caused by large vessel vasculitis (LVV), including giant cell arteritis, Takayasu's arteritis, immunoglobulin G4-related aortitis, and isolated aortitis. There are distinct differences in the clinical presentation, imaging findings, and natural history of LVV that are important for the cardiovascular provider to know. If possible, histopathologic specimens should be obtained to aide in accurate diagnosis and management of LVV. In most cases, corticosteroids are utilized in the acute phase, with the addition of steroid-sparing agents to achieve disease remission while sparing corticosteroid toxic effects. Endovascular and surgical procedures have been described with success but should be delayed until disease control is achieved whenever possible. Long-term management should include regular follow-up with rheumatology and surveillance imaging for sequelae of LVV.
炎性主动脉炎最常由大血管血管炎（LVV）引起，包括巨细胞动脉炎、Takayasu 动脉炎、免疫球蛋白 G4 相关主动脉炎和孤立性主动脉炎。LVV 的临床表现、影像学表现和自然病程有明显差异，心血管医生对此应有充分了解。如果可能，应获取组织病理学标本以辅助 LVV 的准确诊断和治疗。在大多数情况下，急性阶段使用皮质类固醇，同时使用皮质类固醇保存剂来实现疾病缓解，同时避免皮质类固醇的毒性作用。已经描述了血管内和手术方法的成功应用，但应尽可能延迟到疾病得到控制后再进行。长期管理应包括定期接受风湿病学随访和影像学监测，以了解 LVV 的后遗症。
