What other catastrophic outcomes may occur in Giant Cell Arteritis patients with aortic involvement

What other catastrophic outcomes may occur in Giant Cell Arteritis patients with aortic involvement?

Aortitis can lead to aortic aneurysms and dissection. GCA patients have a 17x increased relative risk for developing thoracic aortic aneurysms and a 2.4× risk of abdominal aortic aneurysms compared with controls. Aneurysms and dissection may present with midthoracic or low back pain; these symptoms should be urgently evaluated in any GCA patient. Patients with clinical aortic involvement should be followed with magnetic resonance angiography (MRA) or computed tomography angiography (CTA) every 6 to 12 months for the development of new lesions/stenoses or the development of aneurysms. Surgery or endovascular aneurysm repair is considered when the aneurysm enlarges to >5 cm or dissects.

The appropriate monitoring for GCA patients without known clinical aortic involvement is unclear. Bilateral arm BP measurements, listening for a new aortic insufficiency murmur or arterial bruits, and abdominal palpation for an aortic aneurysm during clinic visits seem prudent. A periodic chest radiograph, echocardiogram, and/or abdominal ultrasound have also been recommended.

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