Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT

Inflammatory aortic aneurysm in a young patient with ankylosing spondylitis

Inflammatory conditions are a rare cause of aortic aneurysms, accounting for 3% to 10% of cases. Patients with ankylosing spondylitis uncommonly present with ascending aortic aneurysms related to long-standing, aggressive disease. We review the case of a young man with ankylosing spondylitis exhibiting complex inflammatory aortic aneurysms atypically involving the abdominal and descending thoracic aorta, as well as ectasia of medium-sized visceral vessels. Inflammatory aneurysms require a multidisciplinary approach incorporating diagnostic modalities to confirm etiology, targeted immunosuppressive therapy to control disease activity, and aneurysm repair. Evidence suggests that endovascular approaches should be considered first-line therapy for patients requiring reconstruction when anatomy is appropriate.

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

BACKGROUND

Endovascular aneurysm repair (EVAR) has been suggested as treatment for inflammatory abdominal aortic aneurysms (IAAA), but the actual clinical and radiological outcomes need to be evaluated.

PURPOSE

To report morphological changes in EVAR of IAAAs.

MATERIAL AND METHODS

Ten male patients (mean age, 67 years; range, 54-78 years) with IAAA were treated with EVAR using endovascular stent-grafts between March 2001 and January 2012. We retrospectively compared computed tomography angiography (CTA) images taken immediately (30 days after the EVAR), short-term (up to 1 year), and mid-term (beyond 1 year) to CTA images taken before the EVAR. Clinical success was defined as successful deployment of the stent-graft without a type I or III endoleak. Morphologic responses of IAAA to EVAR were reviewed by measuring the changes in aneurysm sac maximum diameter (mm), periaortic fibrosis (PAF) thickness (mm), and PAF enhancement (Hounsfield units [HU] on delayed CTA) on serial images.

RESULTS

Ten IAAA patients treated with EVAR were followed for a mean of 42 months (range, 7-129 months). No aneurysm-related deaths were observed during the follow-up of 10 patients. Primary clinical success was achieved in seven patients, assisted primary clinical success in one patient, and secondary clinical success in two patients. Aneurysm sac maximum diameter decreased in all patients (mean percentage reduction of 7.6%, 8.5%, and 17.3% in immediate, short-term, and mid-term follow-up CTA, respectively). PAF thickness decreased in eight patients (10.4%, 16.8%, and 27.2% regression upon follow-up). PAF enhancement decreased in nine patients and increased in one patient (mean percentage decrease of 13.0%, 27.3%, and 40.8% upon follow-up).

CONCLUSION

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