title: Surgical pathology of noninfectious ascending aortitis: a study of 45 cases with emphasis on an isolated variant.
abstract: BACKGROUND
  Aortitis is emerging as an important cause of ascending aortic aneurysm in the elderly. Its features have not been described in a surgical population.
  
  
  METHODS
  Retrospective clinicopathologic review of 45 cases of active noninfectious aortitis among 513 consecutive ascending aortic resections (1985 to 1999).
  
  
  METHODS
  Clinical data were collected from medical records. Histopathologic features were recorded during review of slides stained with hematoxylin-eosin and Verhoeff-van Gieson. Cases were categorized by predefined clinical criteria. Clinicopathologic features were compared among groups, with emphasis on unsuspected aortitis without systemic arteritis.
  
  
  RESULTS
  The 2 largest groups were isolated aortitis (47%) and giant cell arteritis (31%). Other aortitis groups included Takayasu (14%), rheumatoid (4%), and unclassified (4%). Patients with isolated aortitis and giant cell arteritis were generally women (80%; mean age 73 y). All 6 with Takayasu arteritis were women (mean age 26). Although giant cell arteritis and isolated aortitis were histologically indistinguishable, their clinical courses differed substantially. Among 21 patients with isolated aortitis (2 treated with corticosteroids), only 10% later developed aortic aneurysms. In contrast, of 14 patients with giant cell arteritis (11 treated with corticosteroids), 21% subsequently developed aneurysms (P=0.09).
  
  
  CONCLUSIONS
  Aortitis primarily affected women. Patients with isolated aortitis and giant cell arteritis were generally older than 50 years and, by definition, those with Takayasu arteritis were younger. In patients with isolated aortitis, outcomes were generally good, despite the absence of anti-inflammatory therapy. Accordingly, a conservative approach may be warranted for managing this subset of patients with aortitis.
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Dylan V
authors.initials: DV
authors.lastname: Miller
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Isotalo
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Weyand
authors.forename: William D
authors.initials: WD
authors.lastname: Edwards
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Aubry
authors.forename: Henry D
authors.initials: HD
authors.lastname: Tazelaar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001014:Aortic Aneurysm / Q000209:etiology; D001025:Aortitis / Q000150:complications / Q000473:pathology*; D005260:Female; D013700:Giant Cell Arteritis / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000473:pathology; D013625:Takayasu Arteritis / Q000473:pathology