From the Guidelines
Kawasaki disease is the vascular condition that leads to multiple aneurysms, particularly in the coronary arteries, and is characterized by the formation of complex aneurysms without obstruction, as described in the American Heart Association guidelines 1.
Vascular Conditions Leading to Multiple Aneurysms
The condition is marked by large aneurysms, greater than 6 mm, and multiple complex aneurysms in the coronary arteries, which increases the risk of morbidity and mortality due to potential rupture or thrombosis.
- The management of Kawasaki disease involves long-term antiplatelet therapy, and for patients with giant aneurysms, adjunctive therapy with warfarin or low-molecular-weight heparin is recommended 1.
- Regular vascular imaging surveillance, blood pressure control, and surgical or endovascular intervention for aneurysms that reach a critical size or show rapid growth are also crucial in managing the condition.
Pathophysiology and Management
The underlying pathophysiology of Kawasaki disease involves inflammation of the arterial walls, leading to weakening and potential outpouching, which can result in aneurysm formation.
- The condition requires careful monitoring, including annual cardiac stress tests with recommendations about physical exercise, and avoidance of collision and high-impact sports due to the risk of bleeding 1.
- Cardiology evaluation with echocardiogram and ECG should be done at 6-month intervals, and cardiac catheterization with selective coronary angiography may be performed 6 to 12 months after recovery from the acute illness to delineate the complex coronary artery anatomy 1.
From the Research
Vascular Conditions Leading to Multiple Aneurysms
- The vascular condition that leads to multiple aneurysms can be attributed to various factors, including heritable and non-inheritable etiologies 2.
- Systemic multiple aneurysms are rare and usually associated with collagen tissue disease, such as Ehlers-Danlos syndrome (EDS) or Marfan syndrome 3.
- Polyarteritis nodosa, a rare disease characterized by the necrotizing inflammation of medium-sized arteries, can also lead to multiple aneurysms 4.
Characteristics of Patients with Multiple Aneurysms
- Patients with multiple aneurysms are younger at initial diagnosis and differ concerning aneurysm localization compared to patients with a single aneurysm 5.
- The most frequent aneurysm localization shifts from the abdominal aorta and its branches in patients with a single aneurysm to pelvic and leg arteries in patients with at least four aneurysms 5.
- Higher age, hypertension, stenotic disease, presence of multiple (at least three) aneurysms, and primary aneurysm size are predictive of aneurysm co-prevalence 6.
Co-Prevalence of Arterial Aneurysms
- Approximately one in six patients with a primary aneurysm harbors an additional aneurysm, increasing to one in four if the patient has a popliteal artery aneurysm 6.
- At least 19 combinations of aneurysms were described, mostly derived from retrospective studies, with concurrent aneurysms in patients with an abdominal aortic aneurysm being the most common 6.