Isolated aortitis – what to do with the unexpected biopsy report

A few times a year we receive a call from our cardiothoracic colleagues to assist with patients who have inflammation in the thoracic aorta. These patients have usually undergone surgery to repair aortic widening (aneurysm). It is not know if these patients are at higher risk of complications after the operation and if we should treat them with immunosuppression as soon as we receive the biopsy result.

In order to answer these questions, Dr Caterson and a number of our colleagues examined the outcomes of patients who had undergone thoracic aortic surgery from three hospitals (POWH, RPAH and RNSH) over more than 10 years. Of the 1120 patients who had these surgeries, 41 (3.7%) had inflammation on the biopsy. These patients did no better or worse in the 30 days after the operation than the other patients. Most of these patients did not receive anti-inflammatory (immunosuppressive) treatment immediately after the operation and did as well as their peers. Overall, the results are reassuring that we have time to properly assess patients and if they are otherwise well without symptoms of active systemic vasculitis, we can safely wait until the operation wounds have healed before deciding what treatment may be appropriate.