IF 3.8 3区 医学 Q1 RHEUMATOLOGY
Hélène Greigert, Camil-Cassien Bamdé, André Ramon, Eric Steinmetz, Yannick Béjot, Olivier Bouchot, Bernard Bonnotte, Maxime Samson
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引用次数: 0

摘要

除危及生命和/或功能性急症外,巨细胞动脉炎(GCA)血管病变的治疗均为药物治疗。如果在接受最佳药物治疗后病变仍无症状或仍在进展,则可考虑进行血管重建,但前提是不存在与疾病相关的炎症,并始终由训练有素的专家团队进行管理。主动脉受累(大动脉炎)的主要风险是经过数年进展后形成动脉瘤,最常见的是胸主动脉。治疗这些动脉瘤的适应症和手术技术与普通人群相同。在外周动脉疾病中,病变的特点是动脉旁增厚、狭窄,有时甚至闭塞,可导致劳累性跛行或慢性永久性缺血。对这些狭窄病变进行开放或血管内手术治疗时,经常会因血管再狭窄而复杂化。血管内技术在炎症病变治疗中的作用还存在争议,但人们更倾向于开放手术,尤其是在下肢。颈动脉和脑动脉也存在狭窄导致中风的风险。在 GCA 期间对颈动脉或脑动脉进行球囊扩张和/或支架植入术具有很高的破裂和再狭窄风险,因此仍然是一种抢救性治疗方法,仅限于某些特定的中风病例,在这些病例中,如果不采取干预措施,患者的预后令人担忧。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Giant cell arteritis: role of surgery in the management of vascular complications.

Apart from life-threatening and/or functional emergencies, treatment of vascular lesions in giant cell arteritis (GCA) is medical. Revascularization may be considered if the lesion remains symptomatic or progressive despite optimal medical treatment, provided that there is no disease-related inflammation, and always managed by a team of trained experts. The main risk associated with aortic involvement (aortitis) is the development of an aneurysm, most often in the thoracic aorta, after several years of progression. Indications and surgical techniques used to manage these aneurysms follow the recommendations for the general population. In peripheral artery disease, lesions are characterized by parietal thickening, stenosis and sometimes occlusion, which can lead to exertional claudication or chronic permanent ischemia. Open or endovascular surgical management of these stenotic lesions is frequently complicated by restenosis. The role of endovascular techniques in the management of inflammatory lesions is debated, but there is a preference for open surgery, particularly in the lower limbs. Cervical and cerebral arteries also present a risk of stenosis leading to stroke. Balloon dilation and/or stenting of cervical or cerebral arteries during GCA carries a high risk of rupture and restenosis, and remains a rescue treatment limited to certain specific cases of stroke where there are concerns about patient prognosis in the absence of intervention.

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来源期刊
Joint Bone Spine
Joint Bone Spine 医学-风湿病学
CiteScore
4.50
自引率
11.90%
发文量
184
审稿时长
25 days
期刊介绍: Bimonthly e-only international journal, Joint Bone Spine publishes in English original research articles and all the latest advances that deal with disorders affecting the joints, bones, and spine and, more generally, the entire field of rheumatology. All submitted manuscripts to the journal are subjected to rigorous peer review by international experts: under no circumstances does the journal guarantee publication before the editorial board makes its final decision. (Surgical techniques and work focusing specifically on orthopedic surgery are not within the scope of the journal.)Joint Bone Spine is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.
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