Inflammatory abdominal aortic aneurysms: A thirty-year review

Abstract

The operative records of 2816 patients undergoing repair for abdominal aortic aneurysm (AAA) from 1955 to 1985 were reviewed. Inflammatory aortic or iliac aneurysms were present in 127 patients (4.5%), 123 men and four women. Most patients were heavy smokers (92.1%). Clinical evidence of peripheral arterial occlusive disease and coronary artery disease was found in 26.6% and 39.4%, respectively. Additional aneurysms occurred in half of the patients; iliac aneurysms were the most common (55 patients), followed by thoracic or thoracoabdominal (17 patients), femoral (16 patients), and popliteal aneurysms (10 patients). Ultrasound and computed tomography suggested the diagnosis in 13.5% and 50%, respectively; angiography was not helpful. Excretory urographic findings of medial ureteral displacement or obstruction suggested the diagnosis in 31.4%. The aneurysm was repaired in 126 patients. Only one patient experienced acute aneurysm rupture, but eight patients had chronic contained leakage. When compared with patients who have ordinary atherosclerotic aneurysms, patients with inflammatory aneurysms are significantly more likely to have an elevated erythrocyte sedimentation rate (ESR, 73% vs. 33%, p less than 0.0001); weight loss (20.5% vs. 10%, p less than 0.05); symptoms (66% vs. 20%, p less than 0.0001); and an increased operative mortality rate (7.9% vs. 2.4%, p less than 0.002). The triad of chronic abdominal pain, weight loss, and elevated ESR in a patient with an abdominal aortic aneurysm is highly suggestive of an inflammatory aneurysm and may be beneficial in the preoperative preparation of the patient for aneurysm repair.

Long‐term Outcome after Inflammatory Abdominal Aortic Aneurysm Repair: Case‐matched Study

“…It should be noted that the number of patients in this study is fairly small because of the strict criteria adopted to define the inflammatory AAA; our prevalence is in fact relatively low (2.8%) compared with other previously reported experiences [2,3,7,8,17]. However, the selection procedure allowed us to obtain two groups with similar preoperative risk factors followed by periodic instrumental examination and to make the groups strictly comparable.…”

“…Imaging follow-up studies of graftrelated complications in comparison with those of noninflammatory AAAs have rarely been reported [14][15][16]. Some experiences using a clinical follow-up examination showed no significant differences in long-term survival rates between inflammatory and noninflammatory AAAs [6,7,16,17].…”

“…[2] It is not certain whether they have an independent pathogenesis or simply represent the extreme end in the spectrum of inflammatory changes present in all AAAs and even in atherosclerotic plaques [2][3][4][5]. Nevertheless, they may be considered a distinct clinical entity because of their histologic features and associated surgical problems [2,[6][7][8][9]. Almost all reports concerning late outcomes after inflammatory AAA repair have focused on the evolution of perianeurysmal fibrosis [10][11][12][13].…”

Inflammatory Abdominal Aortic Aneurysm Followed by Disseminated Intravascular Coagulation and Immune Thrombocytopenia.

“…The disease is predominantly seen in males and shows a good clinical course. Abdominal pain, elevation of erythrocyte sedimentation rate, and body weight loss are triad of the disease, and CT scan establishes the diagnosis (4,9,12). The IAAAis distinguishable from noncomplicated atherosclerotic aneurysm by the presense of dense perianeurysmal fibrosis and a thickened aortic wall (1-3).…”

“…The incidence of the disease among aortic aneurysms ranges from 2 to 15% (3)(4)(5)(6)(7)(8)(9). Weencountered a patient with IAAAwho had disseminated intravascular coagulation (DIC) and immune thrombocytopenic purpura (ITP).…”