Endovascular Repair of Inflammatory Aortic Aneurysms: Long-Term Results

Puchner, Stefan B.; Bucek, Robert A.; Loewe, Christian; Hoelzenbein, Thomas; Kretschmer, G.; Reiter, Markus; Lämmer, Johannes

doi:10.2214/ajr.04.1881

Cited by 26 publications

(29 citation statements)

References 20 publications

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“…Some studies report that EVAR can reduce the risk of complications, offering comparative early and mid-term results, especially in terms of aneurysm exclusion and rupture prevention. [9][10][11] These results have been confirmed by a meta-analysis and a report from the Eurostar database. 12,13 This retrospective study aims to evaluate the long-term results in terms of aneurysm-related mortality, PAF changes, aneurysm sac evolution, and hydronephrosis progression of IAAA treated with EVAR.…”

Section: Introductionsupporting

confidence: 60%

“…Several other individual series and some meta-analyses have also reported PAF regression. [9][10][11][19][20][21][22][23][24][25][26] A meta-analysis published in 2005 reported complete PAF regression in 51% of patients, unchanged in 42%, and progression in 7%, concluding that EVAR for IAAA is feasible and reduces PAF. 12 No PAF progression was noted in this series.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Inflammatory Abdominal Aortic Aneurysm Endovascular Repair into the Long-Term Follow-Up

Coppi¹,

Rametta²,

Aiello³

et al. 2010

Annals of Vascular Surgery

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Section: Introductionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Inflammatory Abdominal Aortic Aneurysm Endovascular Repair into the Long-Term Follow-Up

Coppi¹,

Rametta²,

Aiello³

et al. 2010

Annals of Vascular Surgery

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“…CT findings Persistent ureteral obstruction a , n (%) CR, n (%) PR, n (%) NR, n (%) 42 3 (38) 2 (24) 3 (38) 1/2 (50) Overall 7 (14) 24 (46) 21 (40) 10/19 (56) CT, computed tomographic; CR, complete regression; PR, partial regression; NR, no regression. a No.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23][24] Two other articles 25,26 were excluded because data from these case-series were confirmed to be included in more recent articles. 42,45 Hence, 19 studies were included in our statistical analysis. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The following data were extracted from each article: number of study patients with inflammatory AAA; age (years) and sex of the patients; followup duration after the intervention (months); number of patients with uni-or bilateral ureteral obstruction at presentation; type of procedure (open surgical or EVAR); number of patients with concurrent ureterolysis during open surgical aneurysm repair; number of patients with pre-operative CT scanning and at follow-up; number of patients with persistent ureteral obstruction after aneurysm repair; CTdocumented evolution of peri-aortic fibrosis (complete, partial or no regression; progression).…”

Section: Selection and Data Extractionmentioning

confidence: 99%

Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature

et al. 2008

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Data on the outcome of aneurysmal chronic peri-aortitis ('inflammatory aneurysm') after open surgical aneurysm repair are few and contradictory. To what extent this inflammatory process is reversed after endovascular aneurysm repair (EVAR) is even more unclear. The objective of this review was to study the outcome of peri-aortic fibrosis (PAF) and ureteral obstruction in patients with aneurysmal chronic peri-aortitis treated with open surgery or EVAR. Medical literature was searched for pertinent articles on the outcome of PAF and ureteral obstruction after open surgery or EVAR from 1970 through October 2007. Studies were included if specific follow-up data were available on outcomes of interest. A total of 19 studies were included comprising 478 patients (open surgical, n = 426; EVAR, n = 52). Age, sex and percentage of patients with ureteral obstruction (31% vs 37%) did not differ between groups. Regression of PAF occurred more frequently after open surgery compared to EVAR (86% vs 60%; p < 0.0001). Complete regression of PAF was more frequent after open surgery compared to EVAR (52% vs 14%; p < 0.0001). After excluding patients in whom concurrent ureterolysis was performed, the frequency of persistent ureteral obstruction remained lower in patients treated surgically compared to patients treated with EVAR, albeit not statistically significant (32% vs 56%; p = 0.09). In conclusion, although open surgery is superior to EVAR in achieving regression of chronic periaortitis, the frequency of persistent PAF and/or ureteral obstruction is not negligible. Additional medical and/or urological treatment should be considered in selected cases of aneurysmal chronic peri-aortitis.

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“…25,82,106) The therapeutic corticosteroid doses for IgG4-related disease are still unclear. Generally, high-dose corticosteroid therapy is started, tapered over a few months, and then a maintenance dose is administered for several years.…”

mentioning

confidence: 99%

IgG4-Related Cardiovascular Disorders

2014

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SummaryImmunoglobulin4 (IgG4)-related disease is a systemic inflammatory disease characterized by elevation of serum IgG4. It involves various organs such as the pancreas (autoimmune pancreatitis), lacrimal gland (Mikulicz's disease), retroperitoneum (retroperitoneal fibrosis), aorta (aortic aneurysm and aortitis), heart (constrictive pericarditis), and pseudotumors around the coronary arteries. These disorders often coexist in accordance with progression of the disease. Because IgG4-related cardiovascular disorder affects the patient's prognosis, early detection and treatment is important. Coronary CT imaging and echocardiography accidentally detect IgG4-related disorders and 18 FDG-PET imaging can identify active inflammation in the lesions. Measurement of serum IgG4 levels and tissue biopsy are necessary for diagnosis. Minor salivary gland biopsy is recommended even though 18 FDG uptake is not detected when it is difficult to obtain a biopsy specimen from IgG4-related cardiovascular lesions. The first-line treatment is high-dose corticosteroid therapy, however, relapse is often reported. Corticosteroids suppress the development of active inflammatory diseases such as aortitis, pericarditis, and pseudotumors, but already-developed lesions do not respond. A large developed aneurysm can rupture even during or after corticosteroid therapy, therefore, additional surgical treatment may be needed. Treatment of IgG4-related cardiovascular disorders might require higher doses of corticosteroids than IgG4-related extracardiovascular disorders. The adequate dose of corticosteroid, type and dose of immunosuppressant, and surgical intervention should be carefully considered on a case-by-case basis. (Int Heart J 2014; 55: 287-295)

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Endovascular Repair of Inflammatory Aortic Aneurysms: Long-Term Results

Abstract: Endovascular aneurysm repair of inflammatory aortic aneurysms excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of periaortic fibrosis with acceptable periinterventional and long-term morbidity.

Cited by 26 publications

References 20 publications

Inflammatory Abdominal Aortic Aneurysm Endovascular Repair into the Long-Term Follow-Up

Inflammatory Abdominal Aortic Aneurysm Endovascular Repair into the Long-Term Follow-Up

Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature

IgG4-Related Cardiovascular Disorders

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