Mid-term clinical outcomes and morphological changes after endovascular aneurysm repair of inflammatory abdominal aortic aneurysms: a single-center experience

Abstract

Background:

Endovascular aneurysm repair (EVAR) has been suggested as treatment for inflammatory abdominal aortic aneurysms (IAAA), but the actual clinical and radiological outcomes need to be evaluated.

Purpose:

To report morphological changes in EVAR of IAAAs.

Material and Methods:

Ten male patients (mean age, 67 years; range, 54–78 years) with IAAA were treated with EVAR using endovascular stent-grafts between March 2001 and January 2012. We retrospectively compared computed tomography angiography (CTA) images taken immediately (30 days after the EVAR), short-term (up to 1 year), and mid-term (beyond 1 year) to CTA images taken before the EVAR. Clinical success was defined as successful deployment of the stent-graft without a type I or III endoleak. Morphologic responses of IAAA to EVAR were reviewed by measuring the changes in aneurysm sac maximum diameter (mm), periaortic fibrosis (PAF) thickness (mm), and PAF enhancement (Hounsfield units [HU] on delayed CTA) on serial images.

Results:

Ten IAAA patients treated with EVAR were followed for a mean of 42 months (range, 7–129 months). No aneurysm-related deaths were observed during the follow-up of 10 patients. Primary clinical success was achieved in seven patients, assisted primary clinical success in one patient, and secondary clinical success in two patients. Aneurysm sac maximum diameter decreased in all patients (mean percentage reduction of 7.6%, 8.5%, and 17.3% in immediate, short-term, and mid-term follow-up CTA, respectively). PAF thickness decreased in eight patients (10.4%, 16.8%, and 27.2% regression upon follow-up). PAF enhancement decreased in nine patients and increased in one patient (mean percentage decrease of 13.0%, 27.3%, and 40.8% upon follow-up).

Conclusion:

Treatment of IAAA with EVAR was effective and reduced aneurysmal sac diameter and the extent of PAF with acceptable morbidity.

Keywords

Abdominal aortic aneurysm inflammatory perianeurysmal fibrosis endovascular procedures stents treatment outcome CT

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References

Barrett

Wells

Roobottom

. Progression of peri-aortic fibrosis despite endovascular repair of an inflammatory aneurysm. Eur J Vasc Endovasc Surg 2001; 21: 567–568.

Chaikof

Blankensteijn

Harris

. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 2002; 35: 1048–1060.

Fillinger

Greenberg

McKinsey

. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 2010; 52: 1022–1033, 33 e15.

Lacquet

Lacroix

Nevelsteen

. Inflammatory abdominal aortic aneurysms. A retrospective study of 110 cases. Acta Chir Belg 1997; 97: 286–292.

Lederle

Wilson

Johnson

. Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J Vasc Surg 1995; 21: 945–952.

Aarts

Schurink

Schultze Kool

. Abdominal aortic aneurysm measurements for endovascular repair: intra- and interobserver variability of CT measurements. Eur J Vasc Endovasc Surg 1999; 18: 475–480.

Coppi

Rametta

Aiello

. Inflammatory abdominal aortic aneurysm endovascular repair into the long-term follow-up. Ann Vasc Surg 2010; 24: 1053–1059.

Sueyoshi

Sakamoto

Uetani

. Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT. Abdom Imaging 2009; 34: 523–526.

Hinchliffe

Macierewicz

Hopkinson

. Endovascular repair of inflammatory abdominal aortic aneurysms. J Endovasc Ther 2002; 9: 277–281.

10.

Puchner

Bucek

Loewe

. Endovascular repair of inflammatory aortic aneurysms: long-term results. Am J Roentgenol 2006; 186: 1144–1147.

11.

Lange

Hobo

Leurs

. Results of endovascular repair of inflammatory abdominal aortic aneurysms. A report from the EUROSTAR database. Eur J Vasc Endovasc Surg 2005; 29: 363–370.

12.

Puchner

Bucek

Rand

. Endovascular therapy of inflammatory aortic aneurysms: a meta-analysis. J Endovasc Ther 2005; 12: 560–567.

13.

Walker

Bloor

Williams

. Inflammatory aneurysms of the abdominal aorta. Br J Surg 1972; 59: 609–614.

14.

Vallabhaneni

McWilliams

Anbarasu

. Perianeurysmal fibrosis: a relative contra-indication to endovascular repair. Eur J Vasc Endovasc Surg 2001; 22: 535–541.

15.

Hodgson

Webster

. Abdominal aortic aneurysm causing duodenal and ureteric obstruction. J Vasc Surg 1986; 3: 364–368.

16.

Hechelhammer

Wildermuth

Lachat

. Endovascular repair of inflammatory abdominal aneurysm: a retrospective analysis of CT follow-up. J Vasc Interv Radiol 2005; 16: 737–741.

17.

Schurmann

Vorwerk

Bucker

. Perigraft inflammation due to Dacron-covered stent-grafts in sheep iliac arteries: correlation of MR imaging and histopathologic findings. Radiology 1997; 204: 757–763.

18.

Cejna

Virmani

Jones

. Biocompatibility and performance of the Wallstent and the Wallgraft, Jostent, and Hemobahn stent-grafts in a sheep model. J Vasc Interv Radiol 2002; 13: 823–830.

19.

Kasashima S, Zen Y, Kawashima A, et al. A new clinicopathological entity of IgG4-related inflammatory abdominal aortic aneurysm. J Vasc Surg 2009;49:1264–1271, discussion 71.

20.

Gilkeson

Allen

. Retroperitoneal fibrosis. A true connective tissue disease. Rheum Dis Clin North Am 1996; 22: 23–38.

21.

Baker

Mallinson

Gregory

. Idiopathic retroperitoneal fibrosis. A retrospective analysis of 60 cases. Br J Urol 1987; 60: 497–503.

22.

Vaglio

Buzio

. Chronic periaortitis: a spectrum of diseases. Curr Opin Rheumatol 2005; 17: 34–40.

23.

Kardar

Kattan

Lindstedt

. Steroid therapy for idiopathic retroperitoneal fibrosis: dose and duration. J Urol 2002; 168: 550–555.

24.

Vaglio

Salvarani

Buzio

. Retroperitoneal fibrosis. Lancet 2006; 367: 241–251.

25.

Crawford

Stowe

Safi

. Inflammatory aneurysms of the aorta. J Vasc Surg 1985; 2: 113–124.

26.

Rasmussen

Hallett

Jr . New insights into inflammatory abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1997; 14: 329–332.

27.

Vaglio

Versari

Fraternali

. (18)F-fluorodeoxyglucose positron emission tomography in the diagnosis and followup of idiopathic retroperitoneal fibrosis. Arthritis Rheum 2005; 53: 122–125.

28.

Stone WM, Fankhauser GT, Bower TC, et al. Comparison of open and endovascular repair of inflammatory aortic aneurysms. J Vasc Surg 2012;56:951–955, discussion 5–6.