Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors


Autoři: Jacques Sellier aff001;  Carma Karam aff001;  Alain Beauchet aff001;  Axel Dallongeville aff001;  Stephen Binsse aff001;  Sandra Blivet aff001;  Isabelle Bourgault-Villada aff001;  Philippe Charron aff002;  Thierry Chinet aff001;  Mélanie Eyries aff002;  Carole Fagnou aff001;  Jérome Lesniak aff001;  Gilles Lesur aff001;  Jérome Lucas aff001;  Agnès Nicod-Tran aff001;  Augustin Ozanne aff001;  Aurélien Palmyre aff002;  Florent Soubrier aff002;  Mostafa El Hajjam aff001;  Pascal Lacombe aff001
Působiště autorů: Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France aff001;  Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France aff002
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226681

Souhrn

Background

Splenic artery aneurysm (SAA) is a rare but potentially fatal condition. Rupture results in 25% mortality up to 75% in pregnant women with 95% fetal mortality. Brief reports suggest an increased risk of developing SAA in patients with HHT.

Methods

We analyzed enhanced multidetector CT data in 186 HHT patients matched (gender and ± 5 year old) with 186 controls. We screened for SAA and recorded diameter of splenic and hepatic arteries and hepatic, pancreatic and splenic parenchymal involvements. We determined by univariate and multivariate analysis, the relationship with age, sex, genetic status, cardiovascular risk factors (CVRF) and visceral involvement.

Results

SAA concerned 24.7% of HHT patients and 5.4% of controls, p<0.001. Factors associated with increased risk of SAA in HHT were female gender (p = 0.04, OR = 2.12, IC 95% = 1.03–4.50), age (p = 0.0003, OR = 1.04, 95% CI = 1.02–1.06) and pancreatic parenchymal involvement (p = 0.04, OR = 2.13, 95% CI = 1.01–4.49), but not type of mutation, hepatic or splenic parenchymal involvements, splenic size or splenic artery diameter or CVRF.

Conclusions

We found a 4.57 higher rate of SAA in HHT patients without evidence of splenic high output related disease or increased CVRF. These results suggest the presence of a vascular intrinsic involvement. It should lead to screening all HHT patients for SAA. The vasculopathy hypothesis could require a change in management as screening of all systemic arteries and even the aorta and to further research in the field.

Klíčová slova:

Aneurysms – Arteries – Blood flow – Cardiovascular diseases – Computed axial tomography – Hypertensive disorders in pregnancy – Medical risk factors – Pregnancy


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