Inflammatory aneurysm in the infrarenal portion of thoracoabdominal aneurysms: An uncommon variant

Abstract

Type IV thoracoabdominal aneurysm with inflammatory changes can be treated at surgery with a retroperitoneal approach. Usually the fibrotic response is confined to the infrarenal portion of the aneurysm.

Long-term Outcome Of Operated Inflammatory Aortic Aneurysms

“…The rest were distributed among aneurysms of the thoracoabdominal aorta (10-15%) and the femoral and visceral vessels. 2,19 It is remarkable that the inflammation of the patients with thoracoabdominal aneurysms was mostly part of the infrarenal portion; in the suprarenal and thoracic segments, there was much less indication of inflammation. 19 In 1978, Goldstone and colleagues described an operative technique that took the special morphologic characteristics of IAA into account (''...as little dissection Outcome of Inflammatory Aortic Aneurysms as possible'').…”

“…2,19 It is remarkable that the inflammation of the patients with thoracoabdominal aneurysms was mostly part of the infrarenal portion; in the suprarenal and thoracic segments, there was much less indication of inflammation. 19 In 1978, Goldstone and colleagues described an operative technique that took the special morphologic characteristics of IAA into account (''...as little dissection Outcome of Inflammatory Aortic Aneurysms as possible''). 9 With an operative technique that has been adapted to the disease that includes limited mobilization of the surrounding structures, the perioperative mortality and morbidity rates could be reduced almost to the levels of AAs.…”

Aneurisma tóraco-abdominal inflamatório

“…Entretanto, quando comparado à correção dos aneurismas infra-renais e para-renais, apresenta índice de mortalidade e morbidade consideravelmente maior 10 . Citamse taxas de mortalidade para esse tipo de aneurisma em torno de 3,1 a 20% em cirurgias eletivas, com uma taxa de isquemia medular em torno de 1,3 a 4,5% e ocorrên-cia de insuficiência renal em 8,8 a 14% dos casos [4][5][6][7][8][9][10][11][12] .…”

“…Em 1972, Walker introduziu o termo aneurisma inflamatório da aorta abdominal (embora James e DeWeerd terem descrito a doença em 1935 e 1955, respectivamente), em que há um espessamento esbranquiçado da parede do vaso e extensa fibrose envolvendo os tecidos adjacentes 4,13 . Esses aneurismas aumentam o risco de complicações durante e após o ato cirúrgico, em função das múltiplas aderências encontradas entre o duodeno (100%), veia renal esquerda (48-51%), veia cava inferior (63-70%), ureteres (20-44%), delgado (20%) e sigmóide (5-20%) 10 .…”

“…A ocorrência de um aneurisma inflamatório envolvendo a aorta tóraco-abdominal é incomum 3,4 . Nesses casos, a necessidade de pinçamento supracelí-aco, associada às múltiplas aderências do processo inflamatório, tornam a cirurgia um grande desafio à equipe vascular.…”