Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Kasashima, Satomi; Kasashima, Fuminori; Kawashima, Atsuhiro; Endo, Makoto; Matsumoto, Yasushi; Kawakami, K.

doi:10.1177/1526602817732316

Cited by 20 publications

(13 citation statements)

References 44 publications

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“…Based on these findings, before surgery, a high serum IgG4/IgG ratio, high MMP-9 concentration, and high monocyte and eosinophil counts would be useful in determining the IgG4-AAA-up subgroup. Furthermore, for patients with IgG4-AAA with these hallmarks, we recommend OSR to prevent the progression of aneurysm [18]. This is because, as previously reported, OSR could provide complete recovery for patients with IgG4-AAA along with longer survival and fewer complications [7][8][9][10][11]18].…”

Section: Discussionmentioning

confidence: 71%

“…However, several recent studies on patients with IgG4-AAA treated by EVAR have reported severe complications leading to death, such as aneurysmal enlargement to rupture or aortoduodenal fistula and aortic dissection [14][15][16][17]. Furthermore, another study, although with a small sample size, compared the prognosis of patients with IgG4-AAA without steroid medication between those treatment by EVAR and those treated by OSR and indicated that approximately half of patients with IgG4-AAA who underwent EVAR were at risk for persistent symptoms, PAF progression, and enlarged aneurysm sac, whereas those treated by OSR did not experience these complications [18]. Considering the severe outcomes of several patients with IgG4-AAA after EVAR [14][15][16][17], a preoperative criterion to predict them would be crucial to select the surgical procedures, and the following postoperative markers would need to be assessed to provide additional treatment for their early recovery.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Kasashima¹,

Kasashima²,

Kawashima³

et al. 2020

Vascul Dis Ther

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Objective: Approximately half of inflammatory abdominal aortic aneurysms, defined by the prominent thickening adventitia, are immunoglobulin G4 (IgG4)related diseases characterized by elevated serum IgG4 and IgG4-positive-plasmacytes infiltration. IgG4-related AAAs (IgG4-AAAs) exhibit vasculitis with elevated inflammatory marker levels. Matrix metalloproteinases (MMPs) degrade the extracellular matrix to destroy the aortic structures to progress aneurysm. This report examined pre-and postoperative serum MMPs and inflammatory marker levels to evaluate the prognosis of IgG4-AAAs after endovascular aortic repair (EVAR).Methods: Among 25 patient with inflammatory abdominal aortic aneurysms (>2-mm-thick periaortic fibrosis) treated with EVAR, IgG4-AAA was diagnosed in 14 patients, and the remaining 11 patients were classified as non-IgG4-AAA. IgG4-AAAs were categorized into cases with increased (IgG4-AAA-up; n = 6) or decreased (IgG4-AAA-down; n=8) postoperative serum IgG4 levels. Before EVAR and after 24 months, we compared the serum MMP, inflammatory marker levels, periaortic fibrosis, and aneurysm diameter.Results: IgG4-AAAs patients showed higher preoperative IL-6 levels, increased postoperative MMP-9 levels, and enlarged postoperative aneurysmal diameters compared with non-IgG4-AAA patients. Among IgG4-AAAs, IgG4-AAA-up exhibited higher preoperative MMP-9, higher preoperative monocytes and eosinophils, increased postoperative MMP-9 and IL-6, and larger aneurysm diameter than IgG4-AAA-down. All patients in IgG4-AAA-down showed shrunk preoperative aneurysm, although almost all patients in IgG4-AAA-up showed enlarged. In IgG4-AAA-up, IgG4/IgG ratio was significantly higher consistently before and after EVAR. MMP-9 was significantly correlated with IgG4 and IL-6. MMP-2 was not significantly different between patients with and without as well as between IgG4-AAA-up and IgG4-AAA-down. Conclusion:Increased postoperative MMP-9 and IL-6 in IgG4-AAA may accelerate aneurysmal progression after EVAR. IgG4-AAA-up exhibited increased IL-6 levels and larger aneurysm diameters following EVAR than IgG4-AAA-down and were considered as the high-risk group with a tendency toward progression. Before surgery, a high IgG4/IgG ratio, high MMP-9 concentrations, a high ratio of monocytes and eosinophils might predict IgG4-AAA-up.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Kasashima¹,

Kasashima²,

Kawashima³

et al. 2020

Vascul Dis Ther

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“…A recent study that described the long-term outcomes of IgG4-RD patients who underwent surgery for AAA reported that re-dilation of the AAA-sac, PAF progression, and worsening of clinical symptoms were frequently observed in IgG4-AAA patients who had undergone EVAR but that these were not seen in patients treated with open surgical repair (OSR). 17 Among the explanations, residual pressure from the stent graft may promote persistent inflammation in the intact aortic wall. Whereas OSR for AAA results in a complete interruption of the blood flow in the aorta, the residual AAA-sac remaining after EVAR may ultimately become filled with blood, particularly in cases of endoleaks.…”

Section: Discussionmentioning

confidence: 99%

Exacerbation of immunoglobulin G4‐related inflammatory abdominal aortic aneurysm after endovascular repair

Kasashima

Kawashima

Kasashima

et al. 2020

Pathology International

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A 78-year-old male was admitted to our hospital with lumbar pain and was found to have an abdominal aortic aneurysm (AAA) and femoral artery aneurysm (FAA). Initially, the patient underwent endovascular aneurysm repair (EVAR) for the AAA and aneurysmectomy for the FAA. The FAA was diagnosed by histology as immunoglobulin G4-related disease (IgG4-RD). The preoperative serum IgG4 level was within the normal range, although a slight serum interleukin-6 (IL-6) elevation was observed. Four years later, the AAA-sac diameter had expanded and the serum levels of both IgG4 and IL-6 levels had increased. Six years after the initial EVAR, aneurysmorrhaphy of AAA-sac was performed. The resected specimen revealed adventitial fibrosis and prominent lymphoplasmacytic infiltrate with regulatory T cells, satisfying histological diagnostic criteria for IgG4-RD. Immunoreactive matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and IL-6 were detected within numerous spindle cells in the adventitia of both the FAA and the AAA-sac. Five months after the aneurysmorrhaphy, the residual AAA-sac was again enlarged with a thickened wall that accumulated [ 18 F] fluoro-2-deoxy-D-glucose (FDG-PET) on positron emission tomography; these findings were paralleled by increased levels of serum IgG4 and IL-6. Therefore, persistent inflammation after EVAR may be attributed to the inflammatory sequelae of IgG4-RD.

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“…Third, the post-therapeutic clinical course might differ between IgG4-related and non-IgG4-related vascular lesions. Fourth, it may be anticipated that the post-operative clinical course may differ from that of the non-IgG4-related cases, in terms of progression of fibrosis, dilation of vessels, and persistence of symptoms [115]. Last, we might be able to alleviate organ hypoperfusion with less invasive medical therapy [11,28], although this possibility should be examined in further analysis.…”

Section: The Value Of a Diagnosis Of Igg4-related Periaortitis/periarmentioning

confidence: 99%

IgG4-related periaortitis/periarteritis: An under-recognized condition that is potentially life-threatening

Mizushima

Kasashima

Fujinaga

et al. 2019

Modern Rheumatology

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Periaortitis and periarteritis are one of the clinical features of IgG4-related disease. Such vascular manifestations are reported to be present in 10-30% of overall IgG4-related disease, and they may also appear as an isolated lesion of IgG4-related disease. As other types of large vessel vasculitis, IgG4related vasculitis may cause significant clinical consequences. On the other hand, the diagnosis of IgG4-related periaortitis/periarteritis seems to have been made on the basis of different diagnostic criteria in reported studies; thus far, difficulty seems to be present in assessing the true frequency of the disease as well as determining the optimal therapeutic strategy. In this review, in addition presenting the clinical and pathological features of IgG4-related periaortitis/periarteirtis, we would like to discuss on what kind of points should be resolved for the better understanding of vascular involvement of IgG4-related disease in terms of diagnosis and treatment.

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Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Cited by 20 publications

References 44 publications

Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Exacerbation of immunoglobulin G4‐related inflammatory abdominal aortic aneurysm after endovascular repair

IgG4-related periaortitis/periarteritis: An under-recognized condition that is potentially life-threatening

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