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An observational study into the management of arteriomegaly: a call for a revised classification system

INTRODUCTION: Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of...

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Autores principales: Barandiaran, JV, Hall, TC, Glaves, I, El-Barghouti, N, Perry, EP
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of Surgeons 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957504/
https://www.ncbi.nlm.nih.gov/pubmed/22613303
http://dx.doi.org/10.1308/003588412X13171221498505
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author Barandiaran, JV
Hall, TC
Glaves, I
El-Barghouti, N
Perry, EP
author_facet Barandiaran, JV
Hall, TC
Glaves, I
El-Barghouti, N
Perry, EP
author_sort Barandiaran, JV
collection PubMed
description INTRODUCTION: Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS: Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS: Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS: This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.
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spelling pubmed-39575042014-03-19 An observational study into the management of arteriomegaly: a call for a revised classification system Barandiaran, JV Hall, TC Glaves, I El-Barghouti, N Perry, EP Ann R Coll Surg Engl Vascular Surgery INTRODUCTION: Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS: Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS: Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS: This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity. Royal College of Surgeons 2012-05 2012-05 /pmc/articles/PMC3957504/ /pubmed/22613303 http://dx.doi.org/10.1308/003588412X13171221498505 Text en Copyright © 2013 Royal College of Surgeons http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Vascular Surgery
Barandiaran, JV
Hall, TC
Glaves, I
El-Barghouti, N
Perry, EP
An observational study into the management of arteriomegaly: a call for a revised classification system
title An observational study into the management of arteriomegaly: a call for a revised classification system
title_full An observational study into the management of arteriomegaly: a call for a revised classification system
title_fullStr An observational study into the management of arteriomegaly: a call for a revised classification system
title_full_unstemmed An observational study into the management of arteriomegaly: a call for a revised classification system
title_short An observational study into the management of arteriomegaly: a call for a revised classification system
title_sort observational study into the management of arteriomegaly: a call for a revised classification system
topic Vascular Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957504/
https://www.ncbi.nlm.nih.gov/pubmed/22613303
http://dx.doi.org/10.1308/003588412X13171221498505
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