Aortitis is an uncommon and often underdiagnosed condition before surgery [1], [2], [3]. Due to its rarity, aortitis frequently goes unnoticed until surgical intervention becomes necessary. In the study by Amemiya et al [1], 75.8% of aortitis cases were diagnosed clinically only after pathological confirmation. In the study by Xu L [2], only 2 of the 21 patients with aortitis were diagnosed with aortitis before surgery, and the rest were diagnosed with aortitis after pathological confirmation.

Aortitis encompasses both rheumatologic and infectious diseases [3]. It seems that the most common causes of aortitis are giant cell arteritis (GCA) and clinically isolated aortitis (CIA) [3]. However, recent studies suggest that the epidemiology of aortitis may vary significantly across different geographical regions and ethnic groups [4], [5], [6], [7]. For instance, GCA seems to mainly affect ethnic groups of northern European ancestry [5], Behçet's syndrome has the highest prevalence along the ancient silk road [5,7]. Given these disparities, investigating the incidence, disease distribution, clinical and pathological features, as well as outcomes of aortitis, is essential.

Histologically, aortitis presents a variety of features, with inflammation being the most common [1,8]. To make progress in identifying the unique pathological aspects of aortitis, we used the 2015 consensus statement on surgical pathology of the aorta [9], [10] to categorize the pattern of inflammation and evaluate histological score. These changes may have significant implications for patient management and prognosis.

This paper aims to address this gap in the literature by presenting a retrospective clinical-pathological study of aortitis in a large cohort of patients who underwent aortic surgery at Wuhan Asia General Hospital in China.