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World J Surg. 1995 Jan-Feb;19(1):127-32.

Pattern of arterial aneurysms in acquired immunodeficiency disease.

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  • 1Department of Cardiothoracic Surgery, Parirenyatwa Hospital, Borrowdale, Harare, Zimbabwe.

Abstract

The ever-spreading incidence of infection with the human immunodeficiency virus (HIV) has introduced a spectrum of unusual, subtle, and often life-threatening lesions that can affect almost every organ and tissue in the body. With the introduction of laboratory serologic evidence of HIV infection, the spectrum of indicator diseases has extended beyond the classic opportunistic infections and Kaposi sarcoma. An analysis of 28 patients in Zimbabwe with focal areas of vascular disease treated during a 4-year period (1989-1993) defined 16 patients ranging in age from 12 to 46 years appropriate for special scrutiny as they evinced none of the usual causes of vascular disease. Twelve of the patients were HIV-positive; in two patients the serologic status was unknown; and two patients were HIV-negative at the time of their presentation. There were special clinical features in this group of patients selected for study: (1) They were young with a mean age of 31 years; (2) they were all indigenous Africans with no evidence of atherosclerosis; and there was (3) rapid development of focal necrotizing vasculitis with aneurysm formation and rupture or (4) slow, progressive development of granulomatous vasculitis. The sites of cardiovascular involvement included the left ventricle; aortic arch; thoracic, thoracoabdominal, and abdominal aorta; and iliac, femoral, gluteal, popliteal, and subclavian arteries. It is inferred that the association between HIV-positive status and arterial aneurysms or fibroproliferative aortic occlusion are causally related and that the principles of vascular surgery can be successfully applied to their treatment.

PIP:

Surgeons conducted an analysis of 28 patients with cardiovascular aneurysms treated at Parirenyatwa Hospital in Zimbabwe during 1989-1993. The age of 16 of these patients ranged from 12 to 46 years. They did not show any customary cause of vascular aneurysms or occlusive disease. 12 of the 16 patients tested positive for HIV. Two were HIV negative at the time. The HIV status of two others was unknown. The sites of vascular involvement included abdominal aorta (3), iliac arteries (3), myocardium (2), thoracic aorta (2), popliteal artery (2), thoracoabdominal aorta (1), femoral artery (1), gluteal artery (1), and subclavian artery (1). The 16 patients were of young age (mean = 31 years), were indigenous Africans with no obvious atherosclerosis, trauma, or other known pathogenetic factors, and manifested rapid development of focal necrotizing arteriopathy with aneurysm formation and rupture and slow, progressive development of granulomatous vasculitis with vascular occlusion. The surgeons recommend excising all infected tissue in cases of mycotic aneurysms and performing extra-anatomic reconstruction to restore vascular continuity. In situ reconstruction is an acceptable alternative, should the surgeon be unable to create extra-anatomic conduits. Bypass procedures should be used to treat cases of occlusive vascular diseases, since the dense fibroproliferative changes thwart safe focal dissection. These findings suggest that HIV positive status has a causative relationship with vascular aneurysms or fibroproliferative aortoiliac occlusion and that this association is not coincidental in a region where HIV infection is common.

PMID:
7740798
[PubMed - indexed for MEDLINE]
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