Endovascular Aneurysm Repair (EVAR) of an Infrarenal Abdominal Aortic Aneurysm (AAA) in a Young Patient with Systemic Lupus Erythematosus (SLE)

Abstract

IntroductionWhile hypertension, pericardial, myocardial, and coronary artery disease are common cardiovascular manifestations of systemic lupus erythematosus (SLE), aortic aneurysms (AA) are rare but increasingly diagnosed, with the true incidence unknown.Case reportA 40 year old female suffering from SLE with a 5.3 cm saccular eccentric infrarenal abdominal aortic aneurysm (AAA) was treated successfully with endovascular aneurysm repair (EVAR) using the Medtronic Endurant II bifurcated stent graft and followed up 2 years post-operatively. Pre-operatively, open and EVAR options were offered and the latter was chosen by the patient.DiscussionProposed mechanisms for AA formation in SLE including accelerated atherosclerosis brought about by chronic steroid use and SLE associated vasculitis and cystic medial degeneration (CMD) have been discussed in other case reports and series. To the authors' knowledge, the use of EVAR for AAA in SLE patients has not been reported in available literature. The need for earlier repair, screening, and detection as well as the long-term suitability, durability, and surveillance of EVAR remain unknown. The benefit of using the Ovation device in minimising late neck dilatation is also discussed.ConclusionEVAR was demonstrated to be a suitable form of repair in a young female patient with SLE and AAA, followed up 2 years post-surgery. The ideal repair and the natural history of these aneurysms remains to be studied.

"Pathophysiology of Vascular Manifestations in Systemic Lupus Erythematosus"

“…In adult-onset SLE patients, numerous cases of aneurysm or dissection of variable severity and of different vessels have been reported with onset at strikingly young ages, among which thoracic [52][53][54]54] and abdominal aortic [54][55][56], coronary [57,58], pulmonary [59], carotid [60], basilar [61], cerebral [62,63], hepatic [64] and mesenteric [65] artery aneurysms. Some cases have been reported as early as in childhood [66] and adolescence [67,68].…”

A systematic review and case presentation: Giant abdominal aortic aneurysm

“…4,5 Other causes of AAA are secondary responses to syphilis, trauma, collagen vascular diseases such as Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, and congenital and inflammatory arteritis such as Takayasu, Horton and Kawasaki disease. 4,[6][7][8][9] Other structural parameters for risk of rupture are wall stress, aneurysm shape, expansion rate, geometrical AAA shape, Peak wall stress and quality of intramural thrombus. 4,10 The risk of rupture of abdominal aortic aneurysm is 14% per year when the size is >6 cm, which increases to 30-50% per year when >8 cm.…”