Long-term Outcome Of Operated Inflammatory Aortic Aneurysms

Abstract

Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs. Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used. Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable. After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.

Open Versus Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

“…Twenty-two series on OSR for IAAA were identified. 1,8 –28 A statistically significant decline in IAAA incidence was observed in studies published after 1999 (3.1% from 5% in earlier studies, P < .001; Table 3), a finding confirmed on meta-regression analysis (Figure 2). Additionally, operative mortality of OSR was significantly reduced by 59% (from 9.8% to 4%, P = .003, odds ratio: 0.38, 95% CI: 0.20-0.74; Table 3) in studies published after 1999.…”

“…Unfortunately, mainly case reports, series, and meta-analyses of EVAR for IAAA have been reported, 2 –5,29 –35 with direct comparison of EVAR with the “gold-standard” OSR being scarce. 22,27 Indeed, our search of the literature retrieved only two nonrandomized comparative studies comparing these two treatment modalities. 22,27…”

“…22,27 Indeed, our search of the literature retrieved only two nonrandomized comparative studies comparing these two treatment modalities. 22,27…”

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

“…11 Early mortality rate with open surgery in inflammatory aneurysm is slightly higher than in atherosclerotic aneurysm and ranges from 6.8% to 11%. [20][21][22][23]30,33,39 Early mortality rate in inflammatory aneurysm with EVAR appears low and similar to that reported with EVAR in atherosclerotic aneurysm (1.9% vs 1.8%). 45,64 Although these data need to be confirmed, EVAR seems associated with a lower early mortality than open surgery in inflammatory aneurysm.…”

“…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).…”