Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

Abstract

Purpose:

To report a single-center experience with endovascular repair of inflammatory abdominal aortic aneurysm (IAAA), with particular attention to the fate of the aneurysm sac, perianeurysmal fibrosis (PAF), and renal function.

Methods:

A retrospective review of 350 patients undergoing endovascular aortic aneurysm repair during a 7-year period at University Hospital, Nottingham, identified 14 (4%) cases of IAAA confirmed either on preoperative spiral computed tomography (CT) or at laparotomy in attempted open aneurysm repair. All data were reviewed from a prospectively maintained database, hospital notes, and serial CT studies.

Results:

Endovascular repair was successfully completed in all 14 IAAA patients, but 2 (14%) died in the perioperative period. One patient referred from another center was lost to imaging follow-up, leaving 11 patients who were followed for a mean 29 months (range 1–73). All 11 IAAAs remained excluded, but 1 patient required a secondary transabdominal intervention for a type III endoleak. There was no CT evidence of PAF progression in any patient. Postoperative renal complications were not encountered where there had been none preoperatively.

Conclusions:

IAAA may be successfully excluded by the endovascular technique, and EVAR is particularly useful where open repair has failed. The impact of endograft placement on perianeurysmal fibrosis is less clear. In this study, there was no suggestion that the degree of PAF worsens following endovascular repair.

Keywords

stent-graft perianeurysmal fibrosis renal function endoleak

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References

Sterpetti

Hunter

Feldhaus

. Inflammatory aneurysms of the abdominal aorta: incidence, pathologic, and etiologic considerations. J Vasc Surg. 1989;9:643–650.

Pennell

Hollier

Lie

. Inflammatory abdominal aortic aneurysms: a thirty-year review. J Vasc Surg. 1985;2:859–869.

Baskerville

Blakeney

Young

. The diagnosis and treatment of peri-aortic fibrosis (‘inflammatory’ aneurysms). Br J Surg. 1983;70:381–385.

Lindblad

Almgren

Bergvist

. Abdominal aortic aneurysm with perianeurysmal fibrosis: experience from 11 Swedish vascular centers. J Vasc Surg. 1991;13:231–239.

Baskerville

Blakeney

Young

. The diagnosis and treatment of peri-aortic fibrosis (‘inflammatory’ aneurysms). Br J Surg. 1983;70:381–385.

Arrive

Correas

Leseche

. Inflammatory aneurysms of the abdominal aorta: CT findings. AJR Am J Roentgenol. 1995;165:1481–1484.

von Fritschen

Malzfeld

Clasen

. Inflammatory abdominal aortic aneurysm: a postoperative course of retroperitoneal fibrosis. J Vasc Surg. 1999;30:1090–1098.

Chuter

Ivancev

Malina

. Inflammatory aneurysm treated by means of transfemoral endovascular graft insertion. J Vasc Interv Radiol. 1997;8:39–41.

Boyle

Thompson

Nasim

. Endovascular repair of an inflammatory aortic aneurysm. Eur J Vasc Endovasc Surg. 1997;13:328–329.

10.

Rehring

Brewster

Kaufman

. Regression of perianeurysmal fibrosis and ureteral dilation following endovascular repair of inflammatory abdominal aortic aneurysm. Ann Vasc Surg. 2001;15:591–593.

11.

Barrett

Wells

Roobottom

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

12.

Vallabhaneni

McWilliams

Anbarasu

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

13.

Todd

DeRose

. Retroperitoneal approach for repair of inflammatory aortic aneurysms. Ann Vasc Surg. 1995;9:525–534.

14.

Bitsch

Norgaard

Roder

. Inflammatory aortic aneurysms: regression of fibrosis after aneurysm surgery. Eur J Vasc Endovasc Surg. 1997;13:371–374.

15.

Speziale

Sbarigia

Grossi

. Inflammatory aneurysms of the abdominal aorta involving the ureters: is combined treatment really necessary? J Urol. 2001;165:27–31.

16.

Nitecki

Hallett

Stanson

. Inflammatory abdominal aortic aneurysms: a case-control study. J Vasc Surg. 1996;23:860–869.

17.

Stella

Gargiulo

Faggioli

. Postoperative course of inflammatory abdominal aortic aneurysms. Ann Vasc Surg. 1993;7:229–238.

18.

Olofsson

Rabahie

Matsumoto

. Histopathological characteristics of explanted human prosthetic arterial grafts: implications for the prevention and management of graft infection. Eur J Vasc Endovasc Surg. 1995;9:143–151.

19.

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.