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Regarding “Peripheral aneurysms and arteriomegaly: is there a familial pattern?”

1999; Elsevier BV; Volume: 30; Issue: 3 Linguagem: Inglês

10.1016/s0741-5214(99)70091-1

1097-6809

P Belardi, G Lucertini,

Galectins and Cancer Biology

We have read the article by Lawrence et al (J Vasc Surg 1998;28:599-605) with interest and believe that it is an important contribution to the studies on the etiology of aneurysmal disease. However, we observed that in this article the term “arteriomegaly” was used erroneously to indicate diffuse aneurysmal disease. This incorrect use of the term causes some confusion because arteriomegaly and diffuse aneurysmal disease are two distinct pathologic entities, as stressed in the 1983 study by Hollier et al1Hollier LH Stanson AW Gloviczki P Pairolero PC Joyce JW Bernatz PE et al.Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.Surgery. 1983; 93: 700-708PubMed Google Scholar and as cited by Lawrence and colleagues as well. Arteriomegaly is a term proposed by Lea Thomas2Lea Thomas M Arteriomegaly.Br J Surg. 1971; 58: 690-694Crossref PubMed Scopus (40) Google Scholar in 1971 to define the condition of diffusely enlarged arteries, which does not necessarily imply aneurysm formation. This condition was previously described by Leriche3Leriche R Dolicho et méga-artère dolicho et méga-veine.Presse Med. 1943; 51: 554-555Google Scholar in 1943 as “dolicho et méga-artère” (which means elongated and enlarged arteries). Diffuse aneurysmal disease is also known as “aneurysmosis,” according to the proposal by Trippel, as reported by Beal.4Beal JM Aneurysmosis.Illinois Medical Journal. 1968; 133: 157-160Google Scholar Aneurysmosis is a term that originates from two Greek words: “aneurysm” (dilation) and “osis” (condition of). This term has been definitively adopted to denote diffuse aneurysmal disease by Hollier and Bower.5Hollier LH Bower TC Arteriomegaly and aneurysmosis.in: Current therapy in vascular surgery. BC Decker, Toronto-Philadelphia1987: 128-132Google Scholar On the basis of the contributions by Hollier and colleagues,1Hollier LH Stanson AW Gloviczki P Pairolero PC Joyce JW Bernatz PE et al.Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.Surgery. 1983; 93: 700-708PubMed Google Scholar, 5Hollier LH Bower TC Arteriomegaly and aneurysmosis.in: Current therapy in vascular surgery. BC Decker, Toronto-Philadelphia1987: 128-132Google Scholar “aneurysmosis” is chosen as the most proper denomination of this entity by others6Lindenauer SM Aortic aneurysm, arteriomegaly, and aneurysmosis.in: 2nd ed. Current therapy in vascular surgery. BC Decker, Philadelphia-Toronto1991: 329-332Google Scholar, 7Mesh CL Graham LM Aortic aneurysm, arteriomegaly, and aneurysmosis.in: 3rd ed. Current therapy in vascular surgery. Mosby-Year Book, St Louis1995: 292-296Google Scholar and by ourselves.8Belardi P Lucertini G Bertoglio C L’aneurismosi: un’entità patologica distinta.Minerva Chir. 1996; 51: 61-65Google Scholar In the fundamental contribution on diffuse aneurysmal disease (or aneurysmosis), Hollier et al1Hollier LH Stanson AW Gloviczki P Pairolero PC Joyce JW Bernatz PE et al.Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.Surgery. 1983; 93: 700-708PubMed Google Scholar classified this entity into three types on the basis of location and extent of the aneurysmal disease: •Type I:aneurysms of the aorta, iliac, and common femoral arteries, with arteriomegaly of the superficial and popliteal arteries;•Type II:aneurysms of the common femoral, superficial, and popliteal arteries, with arteriomegaly of the aorta and iliac arteries;•Type III:aneurysms of the aorta, iliac, femoral, and popliteal arteries, with arteriomegaly of the arteries that are not aneurysmal. As reported, diffuse aneurysmal disease is present in the context of arteriomegaly only in cases with aneurysmal formation (in 30.3% of patients with arteriomegaly in the study by Hollier et al1Hollier LH Stanson AW Gloviczki P Pairolero PC Joyce JW Bernatz PE et al.Arteriomegaly: classification and morbid implications of diffuse aneurysmal disease.Surgery. 1983; 93: 700-708PubMed Google Scholar). In summary, three pathologic arterial conditions must be considered: (1) aneurysm, localized arterial dilation; (2) arteriomegaly, generalized enlargement of the entire arterial system without aneurysm; and (3) aneurysmosis, diffuse aneurysmal disease in patients with arteriomegaly. We hope this contribution leads to a clear distinction among these pathologic conditions and makes this distinction easy to apply in clinical practice. Lastly, our contribution should help overcome persisting confusion in this area of arterial disease.