SYSTEMIC ARTERY ANEURYSMS IN KAWASAKI DISEASE — A COMPREHENSIVE REVIEW
DOI:
https://doi.org/10.48750/acv.154Keywords:
Kawasaki disease, Systemic artery aneurysms, Peripheral aneurysms, small and medium-sized arteries vasculitisAbstract
Introduction: Kawasaki Disease (KD) is a self-limited, unknown-cause febrile vasculitis that predominantly addresses medium-sized arteries and most patients are under 5-years-old. In addition to life-threatening coronary artery involvement, aneurysms may develop in almost any medium-sized vessel, however systemic artery aneurysms (SAA) are described in only 2% of cases. The objective of this study was to identify cases of KD associated SAA and to analyze their frequency, anatomical distribution, treatment and outcomes.
Methods: systematic literature review, performed using MEDLINE database.
Results: Literature review retrieved a total of 9 reports corresponding to 38 patients and a total of 134 KD-SAA. The most affected arteries were the brachial artery (29.8%), the internal iliac artery (18,6%), the common iliac artery (16,4%) and the subclavian artery (11,2%) with bilateral involvement being a common feature. History of concomitant coronary involvement was present in almost every patients. Only 5 SAA (3,7%) required intervention. Medical therapy was associated with SAA regression in approximately half of the patients, with better results when initiated promptly after diagnosis. Worst outcomes were found in younger patients, showing higher rates of morbimortality. The underlying coronary sequelae dictated the prognosis.
Conclusions: Considering their rarity, only multicenter collaboration and literature research can provide more insight about KD-SAA treatment and outcomes, defining the potential role of KD as a primary cause of late vascular lesion. Late presentation KD-SAA may present some diagnostic and therapeutic challenges in view of a more likely need for intervention once the benefit of medical treatment has been outweighed.
Downloads
References
2. Newburger, J. W. et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110, 2747–2771 (2004).
3. Mason, A. NIH Public Access. 19, 389–399 (2009).
4. Satou, G. M., Giamelli, J. & Gewitz, M. H. Kawasaki disease: Diagnosis, management, and long-term implications. Cardiol. Rev. 15, 163–169 (2007).
5. Heran, M. K. S. & Hockley, A. Multiple mirror-image peripheral arterial aneurysms in Kawasaki disease. Pediatr. Cardiol. 32, 670–673 (2011).
6. Hoshino, S., Tsuda, E. & Yamada, O. Characteristics and fate of systemic artery aneurysm after Kawasaki disease. J. Pediatr. 167, 108-112.e2 (2015).
7. Tomita, S., Chung, K., Mas, M., Gidding, S. & Shulman, S. T. Peripheral Gangrene Associated with Kawasaki Disease. Clin. Infect. Dis. 14, 121–126 (1992).
8. Bradway, M. W. & Drezner, A. D. Popliteal aneurysm presenting as acute thrombosis and ischemia in a middle-aged man with a history of Kawasaki disease. J. Vasc. Surg. 26, 884–887 (1997).
9. Bachiri, A. et al. Ischémie de la main révélant une maladie de Kawasaki. 1307–1310 (2000).
10. Ferrante, A., Manni, R., Pintus, C. & Snider, F. Late presentation of brachial artery aneurysm in a child affected by Kawasaki disease —Case report. EJVES Extra 8, 20–22 (2004).
11. Bajolle, F., Jurzak, P., Cohen, S. & Boudjemline, Y. Endovascular treatment of peripheral aneurysms in Kawasaki disease. Arch. Cardiovasc. Dis. 106, 694–696 (2013).
12. Malekzadeh, I., Ziaee, V., Sadrosadat, T., Moardinejad, M. H. & Sayadpour-Zanjani, K. Kawasaki disease and peripheral gangrene in infancy. Iran. J. Pediatr. 25, 10–13 (2015).
13. Coelho, N. H., Barreto, P., Martins, V., Nogueira, C. & Campos, J. Rare Condition , Unusual Anatomy , Elegant Solution e an Uncommon Manifestation of Kawasaki Disease. EJVES Short Reports 42, 12–14 (2019).
14. Cabrera, N. D., Sridhar, A., Chessa, M., Carminati, M. & Report, C. Giant Coronary and Systemic Aneurysms of Kawasaki Disease in an Infant. 915–916 (2010). doi:10.1007/s00246-010-9688-7
15. Takahashi, K., Oharaseki, T. & Naoe, S. Pediatric Cardiology. 138–142 (2001). doi:10.1007/s002460010180
16. Ames, E. L., Jones, J. S., Van Dommelen, B. & Posch, J. L. Bilateral hand necrosis in Kawasaki syndrome. J. Hand Surg. Am. 10, 391–395 (1985).
17. Tsuda, E. et al. Incidence of Stenotic Lesions Predicted by Acute Phase Changes in Coronary Arterial Diameter During Kawasaki Disease. Pediatr. Cardiol. 26, 73–79 (2005).
18. von Planta, M., Fasnacht, M., Holm, C., Fanconi, S. & Seger, R. A. Atypical Kawasaki disease with peripheral gangrene and myocardial infarction: Therapeutic implications. Eur. J. Pediatr. 154, 830–834 (1995).
