Exacerbation of immunoglobulin G4-related inflammatory abdominal aortic aneurysm after endovascular repair.

Published on Aug 4, 2020in Pathology International2.11
· DOI :10.1111/PIN.12998
Satomi Kasashima21
Estimated H-index: 21
(Kanazawa University),
Atsuhiro Kawashima25
Estimated H-index: 25
+ 2 AuthorsSatoru Ozaki19
Estimated H-index: 19
(Kanazawa University)
Sources
Abstract
A 78-year-old male was admitted to our hospital with lumbar pain and was found to have an abdominal aortic aneurysm (AAA) and femoral artery aneurysm (FAA). Initially, the patient underwent endovascular aneurysm repair (EVAR) for the AAA and aneurysmectomy for the FAA. The FAA was diagnosed by histology as immunoglobulin G4-related disease (IgG4-RD). The preoperative serum IgG4 level was within the normal range, although a slight serum interleukin-6 (IL-6) elevation was observed. Four years later, the AAA-sac diameter had expanded and the serum levels of both IgG4 and IL-6 levels had increased. Six years after the initial EVAR, aneurysmorrhaphy of AAA-sac was performed. The resected specimen revealed adventitial fibrosis and prominent lymphoplasmacytic infiltrate with regulatory T cells, satisfying histological diagnostic criteria for IgG4-RD. Immunoreactive matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and IL-6 were detected within numerous spindle cells in the adventitia of both the FAA and the AAA-sac. Five months after the aneurysmorrhaphy, the residual AAA-sac was again enlarged with a thickened wall that accumulated [18 F] fluoro-2-deoxy-D-glucose (FDG-PET) on positron emission tomography; these findings were paralleled by increased levels of serum IgG4 and IL-6. Therefore, persistent inflammation after EVAR may be attributed to the inflammatory sequelae of IgG4-RD.
📖 Papers frequently viewed together
6 Citations
95 Citations
200123.60Circulation
12 Authors (GiuseppeSangiorgi, ..., LuigiInglese)
References18
Newest
#1M. LuisH-Index: 3
#2Luisa BritesH-Index: 2
Last. Armando MalcataH-Index: 8
view all 10 authors...
Vascular involvement in IgG4-related disease (IgG4-RD), is a well-recognized feature and large vessel commitment, especially the aorta, can be the only manifestation of the disease. Being a newly recognized disease, its diagnosis and workup still represents a challenge in clinical practice. A 47-year-old-man with two aortic aneurysms ruptures, one at abdominal and the other at thoracic level, was referred to our rheumatology department. The initial analysis of the surgical specimen obtained 3 ye...
4 CitationsSource
Purpose: To compare the follow-up results of endovascular aneurysm repair (EVAR) vs open surgery (OS) for inflammatory abdominal aortic aneurysms (IAAAs) with regard to immunoglobulin G4–related diseases (IgG4-RD), which are fibrous inflammatory conditions characterized by elevated serum IgG4 concentrations and numerous infiltrations of IgG4+ plasmacytes. Methods: Between January 2005 and December 2015, 91 patients were treated with EVAR (begun in 2008) and 166 patients underwent OS for AAA. For...
6 CitationsSource
#1Satomi KasashimaH-Index: 21
#2Atsuhiro KawashimaH-Index: 25
Last. Kengo KawakamiH-Index: 11
view all 8 authors...
Abstract Objective Immunoglobulin (Ig) G4-related aortic aneurysms (IgG4-AAs) are a special aortic aneurysm among IgG4-related diseases (IgG4-RDs), which are inflammatory and fibrous conditions characterized by tumorous swelling of affected organs and high serum IgG4 concentrations. Recently, IgG4-RD pathogenesis was shown to be associated with T-helper-2 (Th2) and regulatory T (Treg) dominant cytokine production, such as interleukin (IL)-4, IL-10, and IL-13. IL-6 is a key proinflammatory cytoki...
28 CitationsSource
#1Satoshi Yabusaki (Hokkaido University)H-Index: 3
#2Noriko Oyama-Manabe (Hokkaido University)H-Index: 20
Last. Hiroki Shirato (Hokkaido University)H-Index: 63
view all 10 authors...
Background We aimed to assess the positivity, distribution, quantitative degree of vessel inflammation, and clinical characteristics of IgG4-related aortitis/periarteritis and periarteritis (IgG4-aortitis), and to examine the difference in these characteristics between cases with and without IgG4-aortitis, using fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) co-registered with contrast-enhanced CT (CECT). We retrospectively evaluated 37 patients with IgG4-relate...
35 CitationsSource
#1Talha Ijaz (UTMB: University of Texas Medical Branch)H-Index: 10
#2Ronald G. Tilton (UTMB: University of Texas Medical Branch)H-Index: 51
Last. Allan R. Brasier (UTMB: University of Texas Medical Branch)H-Index: 62
view all 3 authors...
On April 29, 2015, Son and colleagues published an article entitled “ Granulocyte macrophage colony-stimulating factor ( GM-CSF ) is required for aortic dissection/intramural haematoma ” in Nature Communications. The authors observed that the heterozygous Kruppel-like transcription factor 6 (KLF6) deficiency or absence of myeloid-specific KLF6 led to upregulation of macrophage GM-CSF expression, promoted the development of aortic hematoma/dissection, and stimulated abdominal aortic aneurysm (AAA...
16 CitationsSource
Purpose:To report a rare and complicated case of immunoglobulin (Ig) G4-related periaortitis involving both the aortic wall and the retroperitoneum without aneurysmal formation.Case Report:A 79-year-old man with IgG4-related periaortitis suffered aortic rupture despite a normal caliber aorta after 6 months of steroid therapy (20 mg/d). Endovascular repair with an aortic cuff sealed the rupture. Steroid therapy was halted 2 weeks later due to infection. Four months later, a biopsy during esophago...
26 CitationsSource
1 CitationsSource
#1Satoshi Yamamoto (UTokyo: University of Tokyo)H-Index: 4
#2Katsuyuki HoshinaH-Index: 13
Last. Toshiaki WatanabeH-Index: 52
view all 7 authors...
We report an autopsy case of aneurysm dissection that occurred 18 months after the implantation of a Zenith stent graft. A 94-year-old woman, who had undergone an endovascular repair with postoperative reintervention, died of shock due to retroperitoneal hematoma. An autopsy indicated that the stent graft remained firmly fixed to the native aorta, whereas the dissection occurred near the proximal edge of the stent graft but not at the point of attachment between the suprarenal stent hook and the...
4 CitationsSource
#1Satomi KasashimaH-Index: 21
#2Atsuhiro KawashimaH-Index: 25
Last. Yasuni Nakanuma (Kanazawa University)H-Index: 87
view all 7 authors...
Background Immunoglobulin (Ig) G4-related disease has recently been recognized to occur in the cardiovascular system in the aorta and main branching arteries, often manifesting as aneurysms and arteritis/periarteritis. Peripheral arteries (the femoral and popliteal arteries) are frequent sites of arteriosclerosis obliterans (ASO) and occasionally show aneurysms or arteritis. This study re-examined peripheral arterial lesions from the standpoint of IgG4-related disease. Methods The study comprise...
23 CitationsSource
#1John H. Stone (Harvard University)H-Index: 76
#2Arezou Khosroshahi (Harvard University)H-Index: 30
Last. Suresh T. Chari (Mayo Clinic)H-Index: 83
view all 39 authors...
John H. Stone, Arezou Khosroshahi, Vikram Deshpande, John K. C. Chan, J. Godfrey Heathcote, Rob Aalberse, Atsushi Azumi, Donald B. Bloch, William R. Brugge, Mollie N. Carruthers, Wah Cheuk, Lynn Cornell, Carlos Fernandez-Del Castillo, Judith A. Ferry, David Forcione, Gunter Kloppel, Daniel L. Hamilos, Terumi Kamisawa, Satomi Kasashima, Shigeyuki Kawa, Mitsuhiro Kawano, Yasufumi Masaki, Kenji Notohara, Kazuichi Okazaki, Ji Kon Ryu, Takako Saeki, Dushyant Sahani, Yasuharu Sato, Thomas Smyrk, James...
447 CitationsSource
Cited By0
Newest