Mid-term clinical outcomes and morphological changes after endovascular aneurysm repair of inflammatory abdominal aortic aneurysms: a single-center experience

Lee, Seung Hyun; Won, Jong Yun; Lee, Do Yun; Kim, Il Jung; Lee, Shin-Jae; Kim, Man Deuk; Park, Sung Il; Lee, Kwang Hun; Ko, Young Guk; Choi, Donghoon; Kim, Min Jung

doi:10.1177/0284185114526591

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…The serial clinical outcome of IAAA after EVAR was recently described. 13 In that report, 1 IAAA patient with autoimmune pancreatitis showed progressive PAF thickening 3 years afterward, whereas 10 other IAAA patients had a tendency toward decreasing PAF. 13 While serum IgG4 was not evaluated, IAAAs with PAF thickening after EVAR might fall into the IgG4+ group.…”

Section: Discussionmentioning

confidence: 85%

“…13 In that report, 1 IAAA patient with autoimmune pancreatitis showed progressive PAF thickening 3 years afterward, whereas 10 other IAAA patients had a tendency toward decreasing PAF. 13 While serum IgG4 was not evaluated, IAAAs with PAF thickening after EVAR might fall into the IgG4+ group. We hypothesized that the consistently active IgG4 state after EVAR may be one of the factors that promote postoperative PAF growth.…”

Section: Discussionmentioning

confidence: 85%

“…9 This is largely due to periaortic fibroinflammatory tissue that adheres to surrounding organs, creating a hostile operating field. Some surgeons have indicated that EVAR is a desirable alternative therapeutic strategy for IAAA, with reduced operative complication risks, 10–14 whereas other reports did not recommend EVAR for IAAA because of progressive postoperative PAF. 15–18…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Kasashima

Kawashima

et al. 2017

J Endovasc Ther

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Kasashima

Kawashima

et al. 2017

J Endovasc Ther

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“…Endovascular aortic repair (EVAR) has become the primary surgical treatment for the majority of patients with IAAAs because of its low invasiveness and difficulties associated with the surgery compared with open surgical repair (OSR) [4][5][6]. Being a relatively newly recognized disease, evidence regarding IgG4-AAA treatment is scarce and controversial.…”

Section: Introductionmentioning

confidence: 99%

Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Kasashima¹,

Kasashima²,

Kawashima³

et al. 2020

Vascul Dis Ther

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Objective: Approximately half of inflammatory abdominal aortic aneurysms, defined by the prominent thickening adventitia, are immunoglobulin G4 (IgG4)related diseases characterized by elevated serum IgG4 and IgG4-positive-plasmacytes infiltration. IgG4-related AAAs (IgG4-AAAs) exhibit vasculitis with elevated inflammatory marker levels. Matrix metalloproteinases (MMPs) degrade the extracellular matrix to destroy the aortic structures to progress aneurysm. This report examined pre-and postoperative serum MMPs and inflammatory marker levels to evaluate the prognosis of IgG4-AAAs after endovascular aortic repair (EVAR).Methods: Among 25 patient with inflammatory abdominal aortic aneurysms (>2-mm-thick periaortic fibrosis) treated with EVAR, IgG4-AAA was diagnosed in 14 patients, and the remaining 11 patients were classified as non-IgG4-AAA. IgG4-AAAs were categorized into cases with increased (IgG4-AAA-up; n = 6) or decreased (IgG4-AAA-down; n=8) postoperative serum IgG4 levels. Before EVAR and after 24 months, we compared the serum MMP, inflammatory marker levels, periaortic fibrosis, and aneurysm diameter.Results: IgG4-AAAs patients showed higher preoperative IL-6 levels, increased postoperative MMP-9 levels, and enlarged postoperative aneurysmal diameters compared with non-IgG4-AAA patients. Among IgG4-AAAs, IgG4-AAA-up exhibited higher preoperative MMP-9, higher preoperative monocytes and eosinophils, increased postoperative MMP-9 and IL-6, and larger aneurysm diameter than IgG4-AAA-down. All patients in IgG4-AAA-down showed shrunk preoperative aneurysm, although almost all patients in IgG4-AAA-up showed enlarged. In IgG4-AAA-up, IgG4/IgG ratio was significantly higher consistently before and after EVAR. MMP-9 was significantly correlated with IgG4 and IL-6. MMP-2 was not significantly different between patients with and without as well as between IgG4-AAA-up and IgG4-AAA-down. Conclusion:Increased postoperative MMP-9 and IL-6 in IgG4-AAA may accelerate aneurysmal progression after EVAR. IgG4-AAA-up exhibited increased IL-6 levels and larger aneurysm diameters following EVAR than IgG4-AAA-down and were considered as the high-risk group with a tendency toward progression. Before surgery, a high IgG4/IgG ratio, high MMP-9 concentrations, a high ratio of monocytes and eosinophils might predict IgG4-AAA-up.

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Juxtarenal Inflammatory Aneurysm Treated with Bilateral Iliac–Renal Bypass Using the Gore Hybrid Device and Total Sealing of the Aneurysmal Sac with a Nellix Device

Martinelli

Malaj

Gattuso

et al. 2017

Annals of Vascular Surgery

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Mid-term clinical outcomes and morphological changes after endovascular aneurysm repair of inflammatory abdominal aortic aneurysms: a single-center experience

Abstract: Treatment of IAAA with EVAR was effective and reduced aneurysmal sac diameter and the extent of PAF with acceptable morbidity.

Cited by 8 publications

References 30 publications

Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms

Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

Juxtarenal Inflammatory Aneurysm Treated with Bilateral Iliac–Renal Bypass Using the Gore Hybrid Device and Total Sealing of the Aneurysmal Sac with a Nellix Device

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