Management of Inflammatory Aortic Aneurysms – A Scoping Review

Caradu, Caroline; Ammollo, Raffaele Pio; Dari, Loubna; Wanhainen, Anders; Herzeele, Isabelle Van; Bellmunt‐Montoya, Sergi; Ducasse, Éric; Bérard, Xavier

doi:10.1016/j.ejvs.2023.01.003

Cited by 11 publications

(5 citation statements)

References 49 publications

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“…Regarding inflAAA, reports are more frequent; thus, the overall prevalence of approx. 5% among all patients might better reflect reality [ 11 ]. To account for that, we also applied a strict histologic criteria for inflAAA ( Figure 2 ) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The state and extent of AAA were identified from the electronic patient file. Additionally, all preoperative CT angiographies were reviewed by two vascular surgeons for signs of rupture, extent of AAA, and mantle signs suggestive of inflammatory AAA [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…In a minority of patients, approx. 5–10%, so-called inflammatory AAA (inflAAA) has been described as a possible link to autoimmune diseases such as giant cell arteritis or Takayasu’s disease with a thickened aortic wall (so-called mantle sign) and possible retroperitoneal fibrosis [ 10 , 11 ]. Here, the involvement of the recognized systemic inflammatory disorder known as immunoglobulin G4 (IgG4)-related disease has been linked to AAA by many groups, suggesting approx.…”

Section: Introductionmentioning

confidence: 99%

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The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort

Nackenhorst,

Kapalla,

Weidle

et al. 2023

JCM

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Abdominal aortic aneurysms (AAA) are the most frequent aortic dilation, with considerable morbidity and mortality. Inflammatory (infl) and IgG4-positive AAAs represent specific subtypes of unclear incidence and clinical significance. Here, histologic and serologic analyses with retrospective clinical data acquisition are investigated via detailed histology, including morphologic (HE, EvG: inflammatory subtype, angiogenesis, and fibrosis) and immunhistochemic analyses (IgG and IgG4). In addition, complement factors C3/C4 and immunoglobulins IgG, IgG2, IgG4 and IgE were measured in serum samples and clinical data uses patients’ metrics, as well as through semi-automated morphometric analysis (diameter, volume, angulation and vessel tortuosity). A total of 101 eligible patients showed five (5%) IgG4 positive (all scored 1) and seven (7%) inflammatory AAAs. An increased degree of inflammation was seen in IgG4 positive and inflAAA, respectively. However, serologic analysis revealed no increased levels of IgG or IgG4. The operative procedure time was not different for those cases and the short-term clinical outcomes were equal for the entire AAA cohort. Overall, the incidence of inflammatory and IgG4-positive AAA samples seems very low based on histologic and serum analyses. Both entities must be considered distinct disease phenotypes. Short-term operative outcomes were not different for both sub-cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort

Nackenhorst,

Kapalla,

Weidle

et al. 2023

JCM

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“…halo sign upon CTA) included in the study showed an average inflammation sum score of 2.3±0.7 and fibrosis grade of 2.6±0.5, all with acute type inflammation (data not shown). [21,33] As previously reported in a subset of patients, these did not correspond to the few cases of immunoglobulin G4 positive samples. [34] The high numbers of lymphoid follicles in AAA tissue reported previously were not seen in our samples.…”

Section: Iiib Vi)[19]mentioning

confidence: 69%

“…The study was performed in accordance with the declaration of Helsinki and tissue sampling was approved by the local ethics committees (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. [21]), maximum diameter (maximum transverse diameter applying multiplane reconstructions from 1-5mm CTangiographies 1-14 days prior to OAR (measurements performed by board-certified vascular surgeon), AAA localization (infra-, juxta-, pararenal; infrarenal = neck length ≥ 10mm ), concomitant iliac aneurysm (one/two sided; common iliac artery ≥ 25mm), co-morbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease CAD, chronic obstructive pulmonary disease COPD, peripheral artery disease (PAD), smoking (current/ex/never), medication (anti-thrombocyte-aggregation, angiotensin-converting-enzyme inhibitor, statin, metformin/insulin) and laboratory results (C-reactive protein CRP, leukocyte/ thrombocyte count, serum creatinine). [3] While baseline clinical data was an inclusion criterion, additional clinical data (not available for all patients, see below) was used for subgroup analysis (Suppl.…”

Section: Patient Identification Inclusion Criteria Ethical Statement ...mentioning

confidence: 99%

Abdominal aortic aneurysms’ histomorphology differs on the individual patient level and is not associated with classic risk factors – the HistAAA study

Nackenhorst,

Menges,

Bohmann

et al. 2024

Preprint

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Objective: Abdominal aortic aneurysm (AAA) treatment is upon a diameter threshold by open (OAR) or endovascular aortic repair. Attempts for medical growth abrogation have failed. This study aims to elucidate the heterogeneity of AAA based on histomorphology in correlation to individual patient data and aneurysm metrics. Patients and Methods: Aneurysm samples from the left anterior wall from four university center biobanks underwent histologic analysis including angiogenesis, calcification, fibrosis, type and grade of inflammation in adventitia and media. Clinical information included age, comorbidities, etc. as well as type of aneurysm (intact, symptomatic, ruptured, inflammatory). Aneurysm morphology included diameter and semi-automated geometric analysis using Endosize (Therenva) segmentation. Additionally, aneurysm growth was assessed. Results: 364 patient samples (85.4% male, median age 69 years) demonstrated acute (mix/granulocytes) or chronic (monocytes/plasma cells) type inflammation and score, coherent in adventitia and media (p < 0.001), not associated with the type of aneurysm (52x ruptured; 37x symptomatic; p = 0.51) or diameter (57 [52-69] mm; p = 0.87). The degree of fibrosis and the presence of angiogenesis were significantly higher (both p < 0.001) with increasing inflammation score, which significantly decreased with patient age (est = - 0.015/year, p = 0.017). No significant differences in inflammation, fibrosis or angiogenesis were seen for ruptured (vs. intact), acute (vs. elective), male (vs. female) of diabetic (vs. non) patients, while current smoking was associated with more chronic inflammation (p = 0.007) and a higher degree of fibrosis (p = 0.03). Aneurysm geometric morphology (n=252) or differing annual growth rates (n=142) were not significantly associated with histologic characteristics. Conclusion: Type and degree of inflammation are the most distinguishable histologic characteristics in the AAA wall between individual patients. Despite the association to age and smoking status, no significant correlation to any patient or aneurysm specific feature, especially not diameter or rupture exists.

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Patient Selection for Endovascular AAA Repair

Sfyroeras

2024

Mastering Endovascular Techniques

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Management of Inflammatory Aortic Aneurysms – A Scoping Review

Cited by 11 publications

References 49 publications

The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort

The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort

Abdominal aortic aneurysms’ histomorphology differs on the individual patient level and is not associated with classic risk factors – the HistAAA study

Patient Selection for Endovascular AAA Repair

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