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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Sterpetti AV, Arici V, Franciscone M, D'Ermo G, Di Marzo L, Carati MV, Costi U, Ragni F, Arbustini E, Bozzani A. Heterogeneous Characteristics of Patients with Inflammatory Abdominal Aortic Aneurysm. Systematic Review of Therapeutic Solutions. Ann Vasc Surg 2023; 97:311-319. [PMID: 37454897 DOI: 10.1016/j.avsg.2023.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Endovascular repair of inflammatory abdominal aortic aneurysms (IAAAs) has emerged as an alternative to open surgery, but direct comparisons are limited. The aim of the study was to compare clinical outcomes of endovascular and open repair for IAAA according with specific clinical characteristics. METHODS We performed a literature review of reports describing patients who had open or endovascular repair for IAAA. A literature search was performed in June 2022 by 2 investigators who conducted a review of papers reported in PubMed, Embase, MEDLINE, and Cochrane Database. The strings "Inflammatory aneurysm" and "Abdominal Aortic Aneurysms" were used. There was no language restriction and screened reports were published from March 1972 to December 2021. We identified 2,062 patients who had open (1,586) or endovascular repair (476) for IAAA. Primary outcomes were operative mortality and morbidity. Secondary outcomes were complications during follow-up (mean follow-up: 48 months). Propensity score matching was performed between patients who had open or endovascular surgery. RESULTS In Western countries, propensity-weighted postoperative mortality (in-hospital) (1.5% endovascular vs. 6% open) and morbidity rates (6% vs. 18%) were significantly lower in patients who had endovascular repair (P < 0.0001); patients with larger aneurysm (more than 7 cm diameter), signs of active inflammation, and retroperitoneal rupture of the aneurysm had better outcomes after endovascular repair than after open surgery. Hydronephrosis was present in 20% of the patients. Hydronephrosis regressed in most patients when signs of active inflammation were present suggesting an acute onset of the hydronephrosis itself (fever, elevated serum C Reactive Protein) either after endovascular or open surgery. Long-standing hydronephrosis as suggested by the absence of signs of active inflammation rarely regressed after endovascular surgery despite associated steroid therapy. During a mean follow-up of 48 months, propensity-weighted graft-related complications were more common in patients who had endovascular repair (20% vs. 8%). For patients from Asia, short-term and medium-term results were similar after open and endovascular repair. IAAAs related with aortitis were more common in Asia. In Western countries, IAAAs were commonly associated with atherosclerosis. CONCLUSIONS Patients with IAAA represent a heterogeneous population, suggesting biological differences from continent to continent; conservative therapy and endovascular or open surgery should be chosen according to the patient clinical condition. Endovascular repair presents advantages in patients with signs of active inflammation and contained rupture of the IAAA and larger aneurysms. Hydronephrosis, without signs of active inflammation, rarely regresses after endovascular repair associated with steroid therapy. Further studies are needed to establish the long-term results of endovascular repair.
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Caradu C, Ammollo RP, Dari L, Wanhainen A, Van Herzeele I, Bellmunt-Montoya S, Ducasse E, Bérard X. Management of Inflammatory Aortic Aneurysms - A Scoping Review. Eur J Vasc Endovasc Surg 2023; 65:493-502. [PMID: 36623764 DOI: 10.1016/j.ejvs.2023.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Inflammatory abdominal aortic aneurysms (InflAAAs) account for 5 - 10% of aortic aneurysms and are characterised by retroperitoneal fibrosis. Diagnosis is often delayed, and doubts remain about the optimal management strategy. This scoping review describes the current state of knowledge on InflAAAs. METHODS Medline, PubMed, EMBASE, and Scopus were searched for relevant studies that evaluated the diagnosis and treatment of InflAAAs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was followed. RESULTS Fifty-seven papers were selected (low level of evidence), which included 1 554 patients, who were mostly male and heavy smokers. A triad of chronic abdominal or back pain, weight loss, and elevated inflammatory markers was highly suggestive of the diagnosis but rarely present, and fever was noted only randomly. A mantle sign was seen on computed tomography angiography (CTA) in 73 - 100% of patients. Open surgical repair (OSR) and endovascular aortic aneurysm repair (EVAR) was reported in 1 376 and 178 patients, respectively. OSR was associated with significant iatrogenic bowel (n = 22), urinary tract system (n = 7), venous (n = 30), pancreatic (n = 6), and splenic (n = 5) injuries, while EVAR was associated with lower 30 day mortality (0 - 5% vs. 0 - 32%). One and two year mortality rates were similar between the two treatment modalities (0 - 20% and 0 - 36%, respectively). EVAR was more often associated with post-operative progression of inflammation (17% vs. 0.4%), and a higher frequency of persistent hydronephrosis (> 50%) and limb occlusion (20%). Used in < 10% of patients, corticosteroids led to complete pain relief and a reduction in peri-aortic inflammation within 6 - 18 months. CONCLUSION InflAAAs are characterised by non-specific symptoms, with the mantle sign on CTA being pathognomonic. Corticosteroids may be considered a basic treatment that all patients should receive initially. Low quality data indicate that EVAR (vs. OSR) is associated with fewer intra-operative complications and lower peri-operative mortality but more late fibrosis related adverse events. International multicentre registries are required to gather more insights into this challenging pathology.
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Affiliation(s)
- Caroline Caradu
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Raffaele P Ammollo
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France; Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Loubna Dari
- Department of Vascular Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Peri-operative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sergi Bellmunt-Montoya
- Department of Vascular and Endovascular Surgery, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Eric Ducasse
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Bérard
- Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France.
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Xu J, Bettendorf B, D'Oria M, Sharafuddin MJ. Multidisciplinary diagnosis and management of inflammatory aortic aneurysms. J Vasc Surg 2022:S0741-5214(22)02645-3. [PMID: 36565773 DOI: 10.1016/j.jvs.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAAs) are a variant involving a distinct immunoinflammatory process, with nearly one half believed to be associated with IgG4-related disease (IgG4-RD). METHODS MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms from January 1970 onward. The search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant studies were selected for review based on their relevance. RESULTS Morphologically, IAAAs are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on fluorine-18 fluorodeoxyglucose-positron emission tomography imaging. A strong association exists with perianeurysmal and retroperitoneal fibrosis. Although the rupture risk appears lower with IAAAs than with noninflammatory abdominal aortic aneurysms (AAAs), the currently recommended diameter threshold for operative management is the same. Open repair has been associated with increased morbidity compared with noninflammatory AAAs, and a retroperitoneal approach or minimal dissection transperitoneal approach has been recommended to avoid duodenal and retroperitoneal structural injuries. Endovascular aneurysm repair has been increasingly used, especially for patients unfit for open surgery. It is important to exclude an infectious etiology before the initiation of immunosuppressive therapy or operative repair. Multimodality imaging follow-up is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed postoperatively for most patients with active systemic disease, especially those with IgG4-RD and those with persistent symptoms. Additional interventions aimed at ureteral decompression could also be required, and lifelong follow-up is mandatory. CONCLUSIONS Preoperative multimodality imaging is a diagnostic cornerstone for assessment of the disease extent and activity. IgG4-RD is an increasingly recognized category of IAAAs, with implications for tailoring adjunctive medical therapy. Open surgical repair remains the procedure of choice, although endovascular aneurysm repair is increasingly being offered. Maintenance immunosuppressive therapy can be offered according to the disease activity as assessed by follow-up imaging studies.
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Affiliation(s)
- Jun Xu
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brittany Bettendorf
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Mel J Sharafuddin
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
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Kharagjitsing HHS, van Vooren J, Brilman EG, Hendriksz TR, van Gelder T, van Bommel EFH. Abdominal aortic diameter and cardiovascular status in patients with idiopathic retroperitoneal fibrosis. Rheumatol Int 2021; 42:1167-1175. [PMID: 34821970 DOI: 10.1007/s00296-021-05051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
Although much debated, an exaggerated inflammatory response to advanced atherosclerosis has been implicated in the pathogenesis of idiopathic retroperitoneal fibrosis (RPF). Clinical presentation, infrarenal abdominal aortic diameter and RPF mass thickness were retrospectively analyzed in 166 patients with idiopathic RPF seen at our referral center between April 1998 and December 2019. Patients were stratified to their infrarenal abdominal aortic diameter at presentation (i.e., non-ectatic [< 25 mm]; ectatic [25-29 mm]; and aneurysmal [≥ 30 mm]) to compare characteristics across groups with an undilated or dilated aorta. Ectatic or aneurysmal aortic dilatation was present in 34% of patients. Most clinical characteristics did not differ across abdominal aortic diameter stratified groups, but RPF mass thickness was greater in patients presenting with aortic aneurysmal dilatation compared to that in patients with an undilated aorta (49.0 mm [IQR 34.0-62.0] vs 32.5 mm [IQR 25.3-47.8]; P < 0.001). A positive linear association was found between aortic diameter on a continuous scale and RPF mass thickness (β 0.32 [95% CI 0.34-0.96]; P < 0.001). This association remained significant after adjusting for age, sex and acute-phase reactant levels (β 0.28 [95% CI 0.15-0.95]; P < 0.01). Treatment success across aortic diameter stratified groups did not differ (P = 0.98). Treatment induced RPF mass regression was not associated with an increase in aortic expansion rate (P = 0.44). Aortic dilatation was prevalent among patients. Infrarenal abdominal aortic diameter was independently associated with RPF mass thickness. Findings support the concept that at least in a subset of patients, RPF may be secondary to advanced atherosclerosis.
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Affiliation(s)
- H H S Kharagjitsing
- Department of Internal Medicine/Dutch National Center of Expertise Retroperitoneal Fibrosis, Albert Schweitzer Hospital, PO Box 444, 3300 AK, Dordrecht, The Netherlands
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - J van Vooren
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - E G Brilman
- Department of Internal Medicine/Dutch National Center of Expertise Retroperitoneal Fibrosis, Albert Schweitzer Hospital, PO Box 444, 3300 AK, Dordrecht, The Netherlands
| | - T R Hendriksz
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - T van Gelder
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - E F H van Bommel
- Department of Internal Medicine/Dutch National Center of Expertise Retroperitoneal Fibrosis, Albert Schweitzer Hospital, PO Box 444, 3300 AK, Dordrecht, The Netherlands.
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Leopardi M, Salerno A, Perilli L, Scarpelli P, Ventura M. Thrombosis of small abdominal aortic inflammatory aneurysm. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tyagi S, Safal S, Tyagi D. Aortitis and aortic aneurysm in systemic vasculitis. Indian J Thorac Cardiovasc Surg 2019; 35:47-56. [PMID: 33061066 DOI: 10.1007/s12055-019-00832-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 02/08/2023] Open
Abstract
The term "large-vessel vasculitis" refers to chronic inflammation affecting the elastic arteries, mainly aorta and its major branches. Large-vessel vasculitis affecting the aorta is termed as "aortitis." This leads to diffuse wall thickening, loss of elasticity, stenosis, occlusion, dissection, calcification or aneurysm formation. Vasculitis involving the aorta includes Takayasu arteritis (commonest large-vessel vasculitis in India), giant cell arteritis (GCA), the periaortitis spectrum (including inflammatory abdominal aortic aneurysm), rheumatic diseases and IgG4-related disease. It is important for physicians to be aware of the aortic manifestations of common vasculitis-so that clinically relevant aortic involvement is not missed. Also, it is equally important for surgeons to keep in mind that aortic aneurysms can have an inflammatory aetiology. The primary reason for this is the central role that immunosuppressive therapy plays in the management of inflammatory aortic aneurysms. Surgical or percutaneous interventions, when needed, are most likely to succeed when performed after activity control; perioperative steroids may be beneficial in select cases, and postoperative disease activity control is imperative.
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Affiliation(s)
- Sanjay Tyagi
- Department Cardiology, Govind Ballabh Pant Hospital, Jawaharlal Nehru Marg, New Delhi, Delhi 110002 India
| | - Safal Safal
- Department Cardiology, Govind Ballabh Pant Hospital, Jawaharlal Nehru Marg, New Delhi, Delhi 110002 India
| | - Dhruv Tyagi
- Department Radiology, Govind Ballabh Pant Hospital, Jawaharlal Nehru Marg, New Delhi, Delhi 110002 India
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Samura M, Morikage N, Mizoguchi T, Takeuchi Y, Nagase T, Harada T, Suehiro K, Hamano K. Recurrent Delayed Periaortitis after Endovascular Aneurysm Repair. J Vasc Interv Radiol 2019; 30:1695-1698. [PMID: 30956078 DOI: 10.1016/j.jvir.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/27/2018] [Accepted: 09/08/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Makoto Samura
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Takahiro Mizoguchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Yuriko Takeuchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Takashi Nagase
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Takasuke Harada
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Kotaro Suehiro
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
| | - Kimikazu Hamano
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Floros N, Papadakis M, Wagenhäuser MU, Duran M, Simon F, Schelzig H, Oberhuber A. Outcomes after Open Surgery for Inflammatory Abdominal Aortic Aneurysm: A 10-Year Single-Center Experience. Ann Vasc Surg 2017; 43:144-150. [PMID: 28478162 DOI: 10.1016/j.avsg.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/23/2017] [Accepted: 04/11/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nikolaos Floros
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Marios Papadakis
- Department of Plastic Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
| | - Markus Udo Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Florian Simon
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
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Igari K, Kudo T, Toyofuku T, Inoue Y. Open Surgical Repair for Inflammatory Abdominal Aortic and Iliac Artery Aneurysms. Ann Vasc Surg 2017; 39:105-110. [DOI: 10.1016/j.avsg.2016.05.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 05/03/2016] [Accepted: 05/15/2016] [Indexed: 11/16/2022]
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13
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Töpel I, Zorger N, Steinbauer M. Inflammatory diseases of the aorta: Part 1: Non-infectious aortitis. GEFASSCHIRURGIE 2016; 21:80-86. [PMID: 27546992 PMCID: PMC4974292 DOI: 10.1007/s00772-016-0143-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aortitis is a term which encompasses inflammatory changes to the aortic wall from various pathogenic etiologies. Large vessel vasculitis, such as Takayasu arteritis and giant cell arteritis represent the most common entities; however, there is also an association with other rheumatological diseases. Chronic idiopathic periaortitis represents a distinct disease entity and infectious aortitis is a rare but life-threatening disease. Due to the diverse clinical pictures vascular surgeons often face a significant challenge in terms of making an accurate initial diagnosis. Treatment requires an interdisciplinary approach. This article describes the pathogenesis of the various forms of aortitis as well as the diagnostic methods and treatment approaches.
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Affiliation(s)
- I. Töpel
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - N. Zorger
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - M. Steinbauer
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
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14
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Kakkos SK, Papazoglou KO, Tsolakis IA, Lampropoulos G, Papadoulas SI, Antoniadis PN. Open Versus Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms. Vasc Endovascular Surg 2015; 49:110-8. [DOI: 10.1177/1538574415602780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Open surgical repair (OSR) of inflammatory abdominal aortic aneurysms (IAAAs) can have significant morbidity. The aim of the present investigation was to compare IAAA outcome after OSR and endovascular aneurysm repair (EVAR) and perform a meta-analysis of the literature. Methods: Twenty-seven patients with an intact IAAA operated on during a 21-year period were included. Results: Nine patients were managed with EVAR and 18 with OSR. In the EVAR group, the number of transfused red blood cell units ( P = .001), procedure duration ( P < .001), and postoperative hospitalization ( P = .004) were significantly reduced compared to OSR. A trend for decreased morbidity with EVAR (11% vs 33% for OSR, P = .36) was observed. On literature review and meta-analysis, morbidity after EVAR was 8.3%, significantly lower compared to OSR (27.4%, P = .047). Mortality for nonruptured IAAAs was 0% after EVAR and 3.6% after OSR ( P = 1.00). Conclusions: Endovascular aneurysm repair of IAAAs is associated with decreased procedure duration, transfusion needs, hospitalization, and morbidity compared to OSR.
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Affiliation(s)
- Stavros K. Kakkos
- Department of Vascular Surgery, University of Patras, Athens, Greece
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15
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Tolenaar JL, van den Ham LH, Reijnen MMPJ, de Vries JPPM. Late Conversion After Sac Anchoring Endoprosthesis for Secondary Aortic Aneurysm Infection. J Endovasc Ther 2015; 22:813-8. [PMID: 26316497 DOI: 10.1177/1526602815601847] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To demonstrate explantation of the Nellix Endovascular Aneurysm Sealing (EVAS) System in the setting of infection. CASE REPORTS Two male patients, 71 and 83 years old, underwent Nellix implantation for asymptomatic infrarenal aortic aneurysms measuring 5.1 and 6.3 cm, respectively. Each developed late infections at 8 and 4 months post EVAS, respectively. The first patient experienced aneurysm rupture after medical therapy failed; the Nellix endosystem was explanted in an uneventful procedure. The second patient developed an aortoduodenal fistula, which was sutured before the Nellix device was removed without complications. The patient died 3 months later, presumably due to ongoing infection. CONCLUSION The need to explant a Nellix EVAS System due to graft infection is a straightforward procedure compared to the removal of a conventional endograft with suprarenal fixation. It requires only temporary suprarenal clamping. The devices can be easily removed due to the lack of penetrating components and without damage to the aortic segment needed to create an anastomosis.
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Affiliation(s)
- Jip L Tolenaar
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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16
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Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm. Case Rep Vasc Med 2015; 2015:531017. [PMID: 26064770 PMCID: PMC4443786 DOI: 10.1155/2015/531017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/23/2022] Open
Abstract
Inflammatory and
juxtarenal Abdominal Aortic Aneurysm (j-iAAA)
represents a technical challenge for open repair
(OR) due to the peculiar anatomy, extensive
perianeurysmal fibrosis, and dense adhesion to
the surrounding tissues. A 68-year-old man with
an 11 cm asymptomatic j-iAAA was
successfully treated with elective EVAR and
chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency
and normal renal function are present at 24-month follow-up. The treatment of j-iAAA can be
technically challenging. ch-EVAR is a feasible
and safe bail-out method for elective j-iAAA
with challenging anatomy.
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17
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Kan-o M, Kado Y, Sadanaga A, Tamiya S, Toyoshima S, Sakamoto M. Immunoglobulin G4-related multiple cardiovascular lesions successfully treated with a combination of open surgery and corticosteroid therapy. J Vasc Surg 2015; 61:1599-603. [DOI: 10.1016/j.jvs.2013.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 01/13/2023]
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18
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Progression of Perianeurysmal Inflammation after Endovascular Aneurysm Repair for Inflammatory Abdominal Aortic and Bilateral Common Iliac Artery Aneurysms. Ann Vasc Surg 2015; 29:364.e1-4. [DOI: 10.1016/j.avsg.2014.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/10/2014] [Accepted: 08/21/2014] [Indexed: 11/24/2022]
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19
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20
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Pak M, Ito S, Takeda M, Watanabe N, Sato H, Ito S, Adachi T, Sugamori T, Endo A, Takahashi N, Yoshitomi H, Ishibashi Y, Tanabe K. A Case of Ascending Aortic Dissection and Rupture Caused by Giant Cell Arteritis. Int Heart J 2014; 55:555-9. [DOI: 10.1536/ihj.14-059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Misun Pak
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Masaki Takeda
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Hirotomo Sato
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Saki Ito
- Division of Cardiology, Shimane University Faculty of Medicine
| | - Tomoko Adachi
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine
| | | | - Hiroyuki Yoshitomi
- Department of Clinical Laboratory, Shimane University Faculty of Medicine
| | - Yutaka Ishibashi
- Department of Community Medicine Management, Shimane University Faculty of Medicine
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine
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21
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22
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23
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Stone WM, Fankhauser GT, Bower TC, Oderich GS, Oldenburg WA, Kalra M, Naidu S, Money SR. Comparison of open and endovascular repair of inflammatory aortic aneurysms. J Vasc Surg 2012; 56:951-5; discussion 955-6. [DOI: 10.1016/j.jvs.2012.03.253] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/14/2012] [Accepted: 03/16/2012] [Indexed: 11/16/2022]
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24
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Stefańczyk L, Elgalal M, Papiewski A, Szubert W, Szopiński P. Infectious or noninfectious? Ruptured, thrombosed inflammatory aortic aneurysm with spondylolysis. Cardiovasc Intervent Radiol 2012; 36:839-43. [PMID: 22972586 PMCID: PMC3646157 DOI: 10.1007/s00270-012-0464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/29/2012] [Indexed: 11/18/2022]
Abstract
Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.
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Affiliation(s)
- Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, ul. Kopcińskiego 22, 90-159 Łódź, Poland
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25
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Periaortic inflammation after endovascular aneurysm repair. Ann Vasc Surg 2011; 25:558.e5-7. [PMID: 21549935 DOI: 10.1016/j.avsg.2010.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/17/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The periaortitis seen with inflammatory abdominal aortic aneurysms usually resolves after repair by both open and endovascular techniques. Conversely, the de novo development of retroperitoneal fibrosis after endovascular aneurysm repair (EVAR) has also been rarely described, and we present a case and also review the literature. METHODS AND RESULTS A 63-year-old man underwent EVAR for an asymptomatic, noninflammatory abdominal aortic aneurysm, presenting 9 months subsequently with left loin pain, raised inflammatory markers, and radiological evidence of periaortic inflammation causing significant left ureteric obstruction. Ureteric stenting resolved the hydronephrosis, and the periaortitis improved with combination of steroid and tamoxifen therapy. CONCLUSION Periaortitis causing renal impairment after EVAR is a rare complication. Prompt recognition and ureteric stenting helps to prevent long-term renal damage. Steroid and tamoxifen therapy is recommended to treat and avoid recurrence of periaortitis.
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26
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Coppi G, Rametta F, Aiello S, Saitta G, Gennai S, Silingardi R. Inflammatory Abdominal Aortic Aneurysm Endovascular Repair into the Long-Term Follow-Up. Ann Vasc Surg 2010; 24:1053-9. [DOI: 10.1016/j.avsg.2010.03.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 11/30/2022]
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27
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McKenna AJ, O'Donnell ME, Collins A, Harkin DW. Endovascular repair of an inflammatory abdominal aortic aneurysm causing bilateral ureteric obstruction. Ir J Med Sci 2010; 181:415-8. [PMID: 20835894 DOI: 10.1007/s11845-010-0569-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 08/24/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conventional open repair of inflammatory abdominal aortic aneurysms (IAAA) remains challenging through the presence of extensive peri-aortic inflammation and fibrosis which makes dissection and vascular control difficult with a risk of inadvertent injury to adjacent visceral structures such as the ureters, duodenum, inferior vena cava, left renal vein and sigmoid colon. METHODS We describe a case of a 69-year-old gentleman who presented with acute renal failure due to bilateral ureteric obstruction in association with an IAAA and discuss the various management options available. CONCLUSION IAAAs and the associated peri-aortic inflammation and fibrosis can be successfully treated using endovascular abdominal aortic aneurysm repair with concurrent ureteric stenting.
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Affiliation(s)
- A J McKenna
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
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28
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Autoantibodies against oxidized low-density lipoprotein and lipid profile in patients with chronic periaortitis: case–control study. Rheumatol Int 2009; 31:201-8. [DOI: 10.1007/s00296-009-1288-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 11/29/2009] [Indexed: 10/20/2022]
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29
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Paravastu SC, Murray D, Ghosh J, Serracino-Inglott F, Smyth JV, Walker MG. Inflammatory Abdominal Aortic Aneurysms (IAAA): Past and Present. Vasc Endovascular Surg 2009; 43:360-3. [DOI: 10.1177/1538574409335915] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: The aim of the study is to determine whether presentation and outcomes of inflammatory abdominal aortic aneurysms (IAAA) have changed over the last five decades. Methods: Comparison of current outcomes (January 2001 to December 2007) with results of the earliest report from our unit in 1972. Results: In contemporary series, 421 patients underwent AAA repair; 38 (9%) were IAAA. In 58% patients, IAAA was an incidental finding, whereas 42% patients were symptomatic with abdominal or back pain. Of those, 32% were ruptured IAAA. Male-to-female ratio was 12:1. Thirty-day mortality was 13%; elective 11.5%; emergency 17%. Comparison with 1972 study showed no change in the incidence and gender predilection. Presentation as an incidental finding and rupture increased 4- and 2-folds, respectively. Conclusion: The incidence and gender predilection of IAAA have remained unchanged. The 4-fold increase in the presentation as an incidental finding reflects current trends in patient evaluation.
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Affiliation(s)
- Sharath C.V. Paravastu
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK,
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Jonathan Ghosh
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | | | - J. Vincent Smyth
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Michael G. Walker
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK
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