Inflammatory aortitis is associated with a 4.5-fold faster preoperative TAA growth rate compared with degenerative aneurysms, with clinically isolated aortitis exhibiting two times the growth rate of giant cell arteritis.
The mean aneurysm growth rate was significantly higher in the aortitis group compared with degenerative TAA controls, representing a 4.5-fold acceleration.
Among inflammatory etiologies, clinically isolated aortitis (CIA) demonstrated faster growth than giant cell arteritis (GCA).
Patients with CIA more frequently required Bentall procedures compared with GCA patients.
No differences were observed in baseline demographics, cardiovascular risk factors, or baseline aortic diameters between the aortitis and control groups.
The majority of aortitis cases exhibited granulomatous inflammation on histological examination.
The study design was a retrospective case-control study using histologically proven aortitis cases matched to degenerative TAA controls.
This research suggests that thoracic aortic aneurysms (enlargements of the main artery leaving the heart) caused by inflammation grow much faster than those caused by the more common degenerative process. The study compared 23 patients whose aneurysms were caused by an inflammatory condition called aortitis — confirmed by tissue samples — with 42 patients who had typical age-related aneurysms. The inflammatory aneurysms grew at roughly 2 mm per year on average, compared to less than half a millimeter per year in the comparison group, making them grow about 4.5 times faster. The study also found important differences within the inflammatory group itself. Patients with 'clinically isolated aortitis' — a form where inflammation occurs without a broader diagnosed disease — had aneurysms growing at over 4 mm per year, roughly twice as fast as those with giant cell arteritis (a well-known inflammatory blood vessel disease). Patients with clinically isolated aortitis also more often needed a more complex surgical procedure called a Bentall procedure, suggesting their disease may be more severe or progress to affect more of the aorta. This research suggests that people with inflammatory causes of aortic aneurysms, particularly clinically isolated aortitis, may need more frequent monitoring and earlier consideration of treatment compared to those with typical degenerative aneurysms. Current surveillance guidelines are largely based on data from degenerative aneurysms, and these findings highlight a potential gap in care for patients with inflammatory disease. The authors call for larger prospective studies to confirm these findings and help refine management strategies for this higher-risk group.
Benichou A, De Gaulmyn M, Guimbrettiere G, Toquet C, Serfaty J, Samoul L, et al.. (2026). Aortitis accelerates the growth rate of thoracic aortic aneurysms.. RMD open. https://doi.org/10.1136/rmdopen-2026-006933