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The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those...
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Context 1
... expected from the selection criteria for the control group, the two groups were similarly matched for age, gender, and surgical priority. Differences between the groups were found regarding clinical presentation and signs but not for preoperative risk factors (Table 1). The incidence of symptoms was in fact significantly higher in group 1 patients, who also had an elevated erythrocyte sedimentation rate (ESR) more often. ...
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Objectives
To evaluate the influence of baseline parameters on the occurrence of stent-graft surface movement after endovascular aneurysm repair (EVAR) and to investigate its association with migration and stent-graft-related endoleaks (srEL).
Methods
In this retrospective, cross-sectional study, three-dimensional surface models of the stent-graft...
Citations
... Furthermore, the inflammatory abdominal aortic aneurysm (IAAA) is considered a distinct variant of abdominal aortic aneurysm which holds the portion of 2-14 % of all cases [9,10] and this notion adds to the scarcity of the presented case in this report. IAAA is characterized by significant thickness of aortic wall, in combination with marked perianeurysmal fibrosis involving adjacent organs [11,12] namely inferior vena cava, ureters, and the third portion of duodenum. The pathophysiology of IAAA is not clear yet. ...
Introduction
Abdominal aortic aneurysm (AAA) and renal cell carcinoma (RCC) coincidence is considered a rare phenomenon. Moreover, the inflammatory nature of aneurysm increases the rarity of the case.
Presentation of case
Our case was a 66-year-old man complaining of constant abdominal pain with a periumbilical pulsatile mass on examination. The computerized tomography angiography revealed a 67*41*44 mm AAA and a 52*43 mm renal mass.
Clinical discussion
Not only choosing the most appropriate treatment is critical when two life-threatening diseases coexist in the same patient but also avoiding from any injury to adjacent organs while releasing fibrotic adhesions due to inflammatory process makes the case more challenging.
Conclusion
The preset study describes the successful one-stage and open surgery for treatment of simultaneous IAAA and RCC.
... The presence of dense adhesions around structures such as the inferior vena cava, ureters and duodenum further challenge management. Mortality rates are between 0.9 -5% for elective aneurysm repair with values similar to the non-inflammatory type [30]. Open IAAA repair was originally adopted however in light of its increased morbidity and mortality, endovascular aneurysm repair (EVAR) has now become increasingly common. ...
Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case shows a classic picture of IgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery.
... The presence of dense adhesions around structures such as the inferior vena cava, ureters and duodenum further challenge management. Mortality rates are between 0.9 -5% for elective aneurysm repair with values similar to the non-inflammatory type [30]. Open IAAA repair was originally adopted however in light of its increased morbidity and mortality, endovascular aneurysm repair (EVAR) has now become increasingly common. ...
Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case shows a classic picture of IgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery. Case Study
... Although spontaneously regressive forms have been described, the most usual outcome is toward the aggravation of the disease. 21,27 In our study, with a mean follow-up duration of 50 months, remission was achieved in nine patients, whereas three patients had steroid resistance. ...
Retroperitoneal fibrosis (RPF) is a rare disease. It is characterized by the presence of fibro-inflammatory tissue involving retroperitoneal structures. The usual mode of presentation of this disease is with lumbar pain, kidney failure, and a biological inflammatory syndrome. The aim of our study is to describe the diagnostic, etiologic, therapeutic aspects and outcomes of RPF in a nephrology unit in Morocco. Twelve cases of RPF were included in our study. The mean age was 57 ± 10 years (32.70). Nine patients were male and three were female. Symptoms were highly variable, dominated by pain that was present in all patients. Venous compressive signs were described in four patients (33.3%), anuria in one patient (8.3%), and hematuria in two patients (16.6%). Laboratory examinations found an inflammatory syndrome in all patients and renal failure in nine patients (75%), with a mean serum creatinine at 35 mg/L ± 8.5. Diagnosis was suspected on the ultrasound data and confirmed by computed tomography or magnetic resonance imaging. RPF was idiopathic in nine patients (75%). It was secondary to aortic aneurysm in one patient (8.3%), Riedel's thyroiditis in one patient (8.3%), and drug induced in another patient (8.3%). All patients received surgical treatment along with corticosteroids. At six months, remission was achieved in nine patients, whereas three others had steroid resistance. These patients were treated by mycophenolate mofetil (MMF) at a dose of 2 g/day; two of them had intestinal intolerance to MMF and thus were treated by tamoxifen at a dose of 40 mg/day. At 24 months, they stabilized their renal function with incomplete regression of the fibrotic plate. No cases of recurrence were observed during the study period.
... In our study, we observed a rupture rate of 8.1%, which is comparable to that of many other studies. 1,4,9,13,21,22,26,27 Hohlbach et al 28 have a different theory regarding rupture rate in iAAA; they found that the higher incidence of symptoms and therefore earlier diagnosis of iAAA prevent rupture in these patients. ...
Objective: The objective of this study was to investigate the long-term outcome after open repair of inflammatory infrarenal aortic aneurysms. Methods: A total of 62 patients (mean age, 68.9 ± 8.8 years; 91.9% male) undergoing open surgery for inflammatory aortic aneurysm from 1995 until 2014 in a high-volume vascular center were retrospectively evaluated. The patients' demographics, preoperative and postoperative clinical characteristics, imaging measurements, and procedural data were collected. Study end points were preoperative and postoperative sac diameter, evolution of periaortic fibrosis and development of hydroureteronephrosis detected by computed tomography (CT) scan, and mortality and morbidity after 30 days and at the time of maximum follow-up. Results: The mean abdominal aortic aneurysm diameter was 67.3 ± 16.7 mm. A total of 30 patients (48.4%) were asymptomatic, 27 patients (43.5%) were symptomatic, and 5 patients (8.1%) were treated for ruptured aneurysm. In 25 patients (40.3%), an aorta-aortic tube graft was implanted; in 37 patients (59.7%), an aortic bifurcation graft was used. Median operating time was 208 minutes (range, 83-519 minutes). Median aortic clamping time was 31 minutes (range, 14-90 minutes); in 25 patients (40.3%), suprarenal aortic cross-clamping was necessary. Hydroureteronephrosis was preoperatively diagnosed by CT scan in 16 patients (25.8%), with the need for a ureteral stent in 11 patients (17.7%). Aneurysm- and procedure-associated 30-day mortality was 11.3% (n = 7), with septic multiple organ failure in four patients and cardiac arrest in three patients. The overall perioperative complication rate was 33.9% (n = 21 patients). Median follow-up was 71.0 months (range, 0.2-231.6 months). At 1 year, 2 years, 4 years, and 6 years, overall survival was 83.4%, 79.6%, 79.6%, and 72.6%, respectively. Six patients (9.7%) required a reintervention during follow-up, predominantly aneurysm related and caused by aortoenteric fistula and graft infection (three of five patients). Median maximum thickness of preoperative perianeurysmal inflammation on CT was 10 mm (range, 2-22 mm), which decreased in 15 of 16 (94%) patients with available postoperative CT scans. Postoperative median thickness of perianeurysmal inflammation on CT was 6 mm (range, 0-13 mm). Hydroureteronephrosis persisted in two of nine (22.2%) patients at the end of follow-up. Conclusions: Surgery in patients with inflammatory abdominal aortic aneurysms is associated with a substantial amount of perioperative complications. After surgery, the perianeurysmal inflammation decreases in most patients on follow-up CT. However, because the inflammatory process does not totally resolve, patients require lifelong surveillance for hydroureteronephrosis and development of aortoenteric fistulas.
... Anastomotic pseudoaneurysms were not seen after OSR in our study, an additional reason that is thought to favor EVAR and not OSR. 20 Our study has certain limitations. Its retrospective nature and the lack of imaging in patients after OSR reduce the value of our conclusions; additionally during the early years, only OSR (n ¼ 4) was feasible, and there has been a steady increase in favor of EVAR throughout the study period. ...
Objectives
Open surgical repair (OSR) of inflammatory abdominal aortic aneurysms (IAAAs) can have significant morbidity. The aim of the present investigation was to compare IAAA outcome after OSR and endovascular aneurysm repair (EVAR) and perform a meta-analysis of the literature.
Methods
Twenty-seven patients with an intact IAAA operated on during a 21-year period were included.
Results
Nine patients were managed with EVAR and 18 with OSR. In the EVAR group, the number of transfused red blood cell units (P = .001), procedure duration (P < .001), and postoperative hospitalization (P = .004) were significantly reduced compared to OSR. A trend for decreased morbidity with EVAR (11% vs 33% for OSR, P = .36) was observed. On literature review and meta-analysis, morbidity after EVAR was 8.3%, significantly lower compared to OSR (27.4%, P = .047). Mortality for nonruptured IAAAs was 0% after EVAR and 3.6% after OSR (P = 1.00).
Conclusions
Endovascular aneurysm repair of IAAAs is associated with decreased procedure duration, transfusion needs, hospitalization, and morbidity compared to OSR.
... 7-10 Successful regression of fibrosis has been reported in a handful of patients with aneurysmal retroperitoneal fibrosis following vascular surgery alone or in combination with immunosuppression. [11][12] Our patient had complete obstruction at the mid-left ureter and high-grade partial obstruction of the right. Bilateral nephrostomy tubes were inserted, and he was discharged on prednisone, 40 mg (approximately 0.5 mg/kg) daily, in combination with mycophenolate mofetil, 1000 mg twice daily. ...
... Walker characterized a group of 19 patients whose aneurysms showed thickness of the aortic wall, with dense perianeurysmal fibrosis involving adjacent organs. 33,34 The reported incidence of IAAAs varies between 2% and 15% of all AAAs. 35,36 The triad of a thickened aneurysmal wall, extensive perianeurysmal and retroperitoneal fibrosis, with adhesions to adjacent abdominal organs, should suggest this entity. ...
... 8,10-12 A study published in 2003 demonstrated a significantly higher percentage of proximal para-anastomotic aneurysms in contrast to patients with AAs as a disease-typical complication of IAA. 10 Information on endovascular aortic replacement for IAA was published recently as both a meta-analysis and an evaluation acquired from the EUROSTAR database. 13,14 The objective of the present report was to analyze early and late complications after aortic repair for IAA, the proportion of proximal paraanastomotic aneurysms, and the status of inflammation after open and endovascular aortic replacement in a single center. ...
... Clinical data acquired after conventional aortic repair of IAA from the recent past vary with regard to morbidity and the status of retroperitoneal fibrosis. [10][11][12] Studies with long-term follow-up that include groups of more than 20 patients are rare. A case-control study published in 2003 described a high incidence of para-anastomic aneurysms of IAA after aortic replacement. ...
... A case-control study published in 2003 described a high incidence of para-anastomic aneurysms of IAA after aortic replacement. 10 The data suggested that the development of para-anastomotic aneurysm may be a disease-typical complication of IAA; certainly, no other studies published focus on this subject. Based on a high incidence of IAA at our own institution, this study was initiated to examine the rate of para-anastomotic aneurysms. ...
Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs.
Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used.
Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable.
After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.
... Aneurysmal exclusion is the principle behind surgery and is aimed at reduction of the inflammatory response and prevention of rupture. With improved surgical techniques, the operative mortality for elective aneurysm repair is as low as 0.9-5% [70] and survival is similar to that of the noninflammatory type [71]. Open repair has been the traditional method, though more recently a transfemoral endoluminal technique using endoprosthesis has been tried successfully [72,73]. ...
Chronic periaortitis commonly involves the infrarenal portion of the abdominal aorta. Idiopathic retroperitoneal fibrosis, inflammatory abdominal aortic aneurysm and perianeurysmal retroperitoneal fibrosis are its various clinical presentations. They present as a non-specific systemic inflammatory disorder and may lead to ureteric obstruction and consequent renal failure. An exaggerated inflammatory response to advanced atherosclerosis has been thought to be the main pathogenetic process. Autoimmunity has also been proposed as a contributing factor. Contrast-enhanced CT scanning is the diagnostic test of choice. Steroids and immunosuppressive agents are successfully used in the treatment of idiopathic retroperitoneal fibrosis and selected cases of inflammatory abdominal aortic aneurysm, and surgery is used in others. Early diagnosis is important in order to reduce morbidity from complications such as renal failure and mortality from aortic rupture.
