255. Aneurysmal Disease in Patients with Takayasu Arteritis: a Canadian Perspective
Creators: name: Frederic Lefebvre1, 3
name: Carolyn Ross2, 3
name: Carette3, Simon
name: Pagnoux3, Christian
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> Takayasu Arteritis (TAK) most often leads to stenotic and occlusive disease. Aneurysmal lesions are rarer, though frequencies vary in literature, likely related to sample size, ethnicity, selection process &amp; imaging modalities used. This study aims to evaluate the frequency, as well as main characteristics, of aneurysmal disease in a Canadian cohort of TAK patients. <strong>Methods:</strong> This single-centre study included TAK patients, followed at Mount Sinai’s Vasculitis Clinic (Toronto), from its inception in 2002 up to January 2021. Diagnosis of TAK was based on clinical presentation, laboratory measures &amp; imaging studies, and/or satisfied the 1990 ACR classification criteria. Baseline demographics, disease-specific characteristics, medical and endovascular treatments were extracted from medical charts, as well as existing centre (CanVasc) database. Information on vascular territory involvement and type of arterial lesion were recorded using reports from available imaging, including conventional angiography, CTA, MRA, PET-Scan and/or TTE/TEE. <strong>Results:</strong> The cohort comprised 74 patients. Aneurysmal disease was found in 23 (31.1%) of them, at any time during their follow-up. Median disease duration, in these 23 patients with aneurysms, was 9 [7-19] years; most were female (87%), of Caucasian (42.9%) or Asian (42.9%) descent (Table 1). Prior hypertension (p = 0.016) was more common in patients with aneurysms, who also reported more fever (p = 0.04), seizure disorders (p = 0.03), but had less vascular symptoms (p = 0.04), such as less limb claudication (p = 0.013), than those without aneurysms. At last follow-up, 22 of these 23 patients had repeat imaging showing persistent and/or new aneurysms (renal aneurysm had regressed in one patient, under medical treatment only). Thoracic aorta aneurysm (n = 13/22 (59.1%)) was the most common, followed by abdominal aorta aneurysm (n = 8/22 (36.4%)). Aorta vasculitis involvement had previously been diagnosed in all of these patients (p = 0.05, for comparison with patients without aneurysms); aortic valve regurgitation was also more frequent (9/23 (39.1%); p = 0.001). Most patients with aneurysms (21/23 (91.3%)) had been treated with glucocorticoids (median duration of 6.1 years [3.7-8.1]). Methotrexate, azathioprine and leflunomide were used in 69.6%, 47.8% &amp; 30.4% of patients, respectively. In patients with aneurysmal disease, infliximab (n = 7/23 (30.4%)) was used more often than in those without (p = 0.04). Tocilizumab was received only by 4/74 patients, all with aneurysmal disease (p = 0.008). At last visit, 65.2% of patients with aneurysms were still on immunosuppressives, compared to 49% without (p = 0.196). Patients with aneurysms suffered more frequent vasculitis relapses (2 [0-4] vs 1 [0-2] in patients without aneurysms; p = 0.038). Aorta repair was required in 5/23 (21.7%) of patients; no aneurysmal rupture or deaths were recorded. <strong> </strong> <strong>Conclusions:</strong> Aneurysmal disease, most often thoracic, was found in a significant proportion of patients with TAK. Given that aneurysms may carry a risk of rupture, and are associated with a higher rate of relapse, they should be analyzed and reported systematically in TAK studies. <strong>Disclosures</strong><strong>:</strong> None