[Aortitis and surgery]. / Prise en charge chirurgicale des maladies inflammatoires de l'aorte.

Non-infectious aortitis are usually due to giant cell arteritis (temporal arteritis), Takayasu and Behçet's diseases. Aortitis should be suspected in the presence of aortic wall thickening or of aneurysm or occlusion of the aorta and its branches in the absence of characteristic cardiovascular risk factors. Surgery is required in case of severe damage. But the quiescence of the inflammatory disease must be obtained before endovascular or surgical treatment to prevent complications such as anastomotic false aneurysm or stent thrombosis, especially common in this disease. The frequency of aortic aneurysms (in particular of ascending aorta) in giant cell arteritis encourages its systematic screening, as well as regular monitoring of the entire aorta during the follow-up. Behçet's and Takayasu diseases require the greatest control of inflammation and the knowledge of some surgical tricks to avoid the risk of recurrence. The literature review shows that endovascular treatment could reduce perioperative morbidity but did not allow reducing long-term complications.

Indications to open surgical repair of the thoracic aorta in the "endovascular" era.

Endovascular techniques have deeply modified the indications to open surgical repair in nearly all the vascular tree and especially in areas where the invasiveness of open surgery is real like the thoracic aorta. However their anatomical and technological limits on one hand and uncertainty on their long term results on the other hand still leave a large place for open surgery. Also, immediate as well as late results of open surgery have continued their progress during the endovascular era, rendering it competitive in trained centers for fit selected patients.