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Cardaci MB, Destraix R, Van Houte B, Vazquez C. Endovascular Repair of Inflammatory Aortic Aneurysms: Experience in a Single Center. Ann Vasc Surg 2019; 58:255-260. [PMID: 30735769 DOI: 10.1016/j.avsg.2018.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysm (IAAA) remained a rare cause of aneurysmal aortic disease, with incidences between 5% and 10%. The current treatment for IAAA consists of open surgical repair and endovascular aneurysm repair (EVAR). Avoiding an inflamed, fibrotic retroperitoneum is the driving force behind the desire to repair IAAA endovascularly. The latest published works confirm the promising results after EVAR for IAAA, but there is still a paucity of data regarding hydroureter and hydronephrosis. In this article, we describe our experience with 5 patients diagnosed with IAAA and treated by EVAR, of whom 3 presented with associated hydronephrosis. METHODS A retrospective review of our endovascular database identified five patients who underwent EVAR for IAAA. Unilateral ureteral involvement in the inflammatory process was seen in 3 patients, accompanied by secondary hydronephrosis. One patient presented retroperitoneal fibrosis with duodenal stenosis. Primary outcomes were primary technical success, aneurysm-related mortality, change in aneurysm size, perianeurysmal fibrosis (PAF), and hydronephrosis. Secondary outcomes were requirement for reintervention, progression/resolution of symptoms, and short-term clinical success. RESULTS Follow-up duration ranged from 3 to 61 months. No patients were lost to follow-up. Primary technical success was obtained in all patients. One patient died three months after the operation due to persistence of the duodenal stenosis in spite of subsequent endoscopic treatments and corticotherapy. The aneurysm sac progressively reduced in 4 patients and remained unchanged in one patient. PAF regressed in 2 patients, reduced in two, and remained unchanged in one patient. Hydronephrosis persisted in all three patients preoperatively diagnosed with this condition. No patient required subsequent intervention. Four patients had complete resolution of their symptoms at a follow-up visit at 1 month. CONCLUSIONS This series suggests that EVAR for IAAA is technically feasible, excludes the aneurysm effectively, and reduces PAF with an acceptable morbidity and mortality rate. EVAR does not seem to offer any benefits for hydronephrosis, and closer follow-up in patients presenting renal or ureter involvement treated by EVAR is necessary.
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Affiliation(s)
- Miguel Bouzas Cardaci
- Department of General, Vascular and Thoracic Surgery, Centre Hospitalière Regional du Val de Sambre Rue Chère-Voie, Sambreville, Belgium.
| | - Renaud Destraix
- Department of Urology, Centre Hospitaliere Regional du Val de Sambre, Sambreville, Belgium
| | - Bernard Van Houte
- Department of Gastroenterology, Centre Hospitaliere Regional du Val de Sambre, Sambreville, Belgium
| | - Cesar Vazquez
- Department of General, Vascular and Thoracic Surgery, Centre Hospitalière Regional du Val de Sambre Rue Chère-Voie, Sambreville, Belgium
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2
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Aortic Aneurysm as a Complication of Granulomatosis with Polyangiitis Successfully Treated with Prednisolone and Cyclophosphamide: A Case Report and Review of the Literature. Case Rep Rheumatol 2018; 2018:9682801. [PMID: 29971178 PMCID: PMC6008675 DOI: 10.1155/2018/9682801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022] Open
Abstract
A 57-year-old Japanese man was admitted to the hospital with back pain and fever, multiple lung nodules, and abdominal aortic aneurysm (AAA). Laboratory tests performed at admission showed an increased proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) level. Video-associated thoracoscopic lung biopsy was performed; pathologic examination showed granulation tissue with necrosis and multinucleated giant cells. The diagnosis of granulomatosis with polyangiitis (GPA) was confirmed on the basis of the clinical presentation, laboratory findings, and lung biopsy. All symptoms were ameliorated, and the serum level of PR3-ANCA declined following treatment with prednisolone and cyclophosphamide. Although the association of GPA with AAA is rare, GPA may be included among the large vessel vasculitides that can give rise to aortic aneurysm.
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3
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Kasashima S, Kasashima F, Kawashima A, Endo M, Matsumoto Y, Kawakami K. Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4–Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms. J Endovasc Ther 2017; 24:833-845. [DOI: 10.1177/1526602817732316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Satomi Kasashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
- Department of Clinical Laboratory, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Fuminori Kasashima
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Atsuhiro Kawashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
- Department of Clinical Laboratory, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Masamitsu Endo
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Yasushi Matsumoto
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Kengo Kawakami
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
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4
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Ockert S, Schumacher H, Böckler D, Ganten M, Seelos R, Allenberg J. Long-term Outcome Of Operated Inflammatory Aortic Aneurysms. Vascular 2016; 14:206-11. [PMID: 17026911 DOI: 10.2310/6670.2006.00035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- Stefan Ockert
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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5
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Duque Santos A, Reyes Valdivia A, Miguel Morrondo A, Ocaña Guaita J. Actualización del diagnóstico y tratamiento de los aneurismas de aorta abdominal inflamatorios. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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7
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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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8
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Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L, Buja LM, Butany J, d'Amati G, Fallon JT, Gittenberger-de Groot AC, Gouveia RH, Halushka MK, Kelly KL, Kholova I, Leone O, Litovsky SH, Maleszewski JJ, Miller DV, Mitchell RN, Preston SD, Pucci A, Radio SJ, Rodriguez ER, Sheppard MN, Suvarna SK, Tan CD, Thiene G, van der Wal AC, Veinot JP. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24:267-78. [PMID: 26051917 DOI: 10.1016/j.carpath.2015.05.001] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener's), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet's disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.
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Affiliation(s)
| | | | | | | | | | | | - L Maximilian Buja
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | | | | | | | | | | | | | | | - Ornella Leone
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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9
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Capoccia L, Riambau V. Endovascular repair versus open repair for inflammatory abdominal aortic aneurysms. Cochrane Database Syst Rev 2015; 2015:CD010313. [PMID: 25879695 PMCID: PMC10679967 DOI: 10.1002/14651858.cd010313.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysm (IAAA) is a rare but potentially life-threatening condition characterised by marked thickening of the aortic wall, peri-aneurysmal and retroperitoneal fibrosis, and dense adhesions of adjacent abdominal organs. The pathogenesis of IAAA remains an enigma. The main aim of invasive or surgical therapy of AAAs is prevention or correction of aortic rupture. Prevention or treatment of AAA rupture by open or endovascular repair is proven by numerous studies published in the literature. Treatment of IAAA poses a different challenge to surgeons compared with traditional atherosclerotic AAA because of the potential for iatrogenic injury in open repair or, alternatively, potential increased inflammatory response to endoprosthesis implantation. OBJECTIVES To assess the effects of elective endovascular versus open repair for inflammatory abdominal aortic aneurysms. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (April 2015) and the Cochrane Register of Studies (CRS) (2015, Issue 3). The TSC searched trial databases for details of ongoing and unpublished studies. SELECTION CRITERIA We sought all published and unpublished randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials comparing results of elective endovascular or open repair of IAAAs without language restriction. DATA COLLECTION AND ANALYSIS Both review authors independently assessed studies identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions. MAIN RESULTS We identified no studies that met the inclusion criteria. AUTHORS' CONCLUSIONS We found no published RCTs, quasi RCTs or controlled clinical trials comparing open repair and elective endovascular repair for IAAA, assessing immediate (30-day), intermediate (up to one-year follow-up) and long-term (more than one-year follow-up) mortality or complications rates. High-quality studies evaluating the best treatment for inflammatory abdominal aneurysm repair are required.
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Affiliation(s)
- Laura Capoccia
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, 155, viale del Policlinico, Rome, Italy, 00161
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10
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Lee SH, Won JY, Lee DY, Kim IJ, Lee SJ, Kim MD, Park SI, Lee KH, Ko YG, Choi DH, Kim EK. Mid-term clinical outcomes and morphological changes after endovascular aneurysm repair of inflammatory abdominal aortic aneurysms: a single-center experience. Acta Radiol 2015; 56:304-11. [PMID: 24609870 DOI: 10.1177/0284185114526591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Seung Hyun Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Do Yun Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Il Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Shin Jae Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Man Deuk Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Sung Il Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Kwang Hun Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Young Guk Ko
- Cardiology Division, Yonsei Cardiovascular Center, Research Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Choi
- Cardiology Division, Yonsei Cardiovascular Center, Research Institute, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Bezmarevic M, Marjanovic I, Sarac M. Commentary: What Is the Appropriate Treatment of Immunoglobulin G4-Related Vascular Lesions? J Endovasc Ther 2014; 21:598-600. [DOI: 10.1583/14-4670.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Takeda Y, Daimon M, Tsuji M, Katsumata T, Morita H, Ishizaka N. Repetitive complications after prosthetic graft for inflammatory aortic aneurysm. SAGE Open Med Case Rep 2013; 1:2050313X13513230. [PMID: 27489635 PMCID: PMC4857269 DOI: 10.1177/2050313x13513230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/10/2013] [Indexed: 11/29/2022] Open
Abstract
The presence of retroperitoneal fibrosis after an aortic graft replacement is a marker of poor prognosis following aortic graft replacement. Herein we report the case of a 39-year-old man with retroperitoneal fibrosis that had been causing ureteral obstruction. The man had undergone repeated aortic graft replacement due to bacteremia and aortic graft–small intestinal fistula that occurred 4 years after initial aortic grafting for an inflammatory aortic aneurysm. The patient was discharged after 4 weeks of intravenous antibiotic therapy following the latest aortic graft replacement.
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Affiliation(s)
| | - Masahiro Daimon
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Motomu Tsuji
- Division of Pathology, Osaka Medical College, Osaka, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Hideaki Morita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
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13
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14
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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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15
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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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16
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Hong S, Park HK, Shim WH, Youn YN. Hybrid endovascular repair of thoracic aortic aneurysm in a patient with Behçet's disease following right to left carotid-carotid bypass grafting. J Korean Med Sci 2011; 26:444-6. [PMID: 21394316 PMCID: PMC3051095 DOI: 10.3346/jkms.2011.26.3.444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 11/18/2010] [Indexed: 11/22/2022] Open
Abstract
Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behçet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.
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Affiliation(s)
- Soonchang Hong
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Han Ki Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Won-Heum Shim
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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17
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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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19
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West CA, Khan IR, Doucet L, Boudreaux MB, Johnson LW. Giant pararenal abdominal aortic aneurysm. Ann Vasc Surg 2010; 24:950.e3-6. [PMID: 20599345 DOI: 10.1016/j.avsg.2010.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
Inflammatory aortic aneurysms are unusual vascular lesions and most commonly involve the infrarenal segment of the abdominal aorta. These complex aneurysms represent a challenge to the vascular surgeon and become even more difficult as the extent of the aneurysm and size of the inflammatory mass increase. Although well described, few cases of giant inflammatory aneurysms are reported. In this case, we review the clinical presentation and surgical management of a patient with a giant pararenal abdominal aortic aneurysm and highlight an uncommon morphologic pattern of aortic disease and provide a review of relevant literature.
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Affiliation(s)
- Charles A West
- Department of Surgery, Division of Vascular and Endovascular Surgery, Louisiana State University Health Science Center, Shreveport, LA, USA.
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20
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Miyashita T, Yoshioka K, Shibata M, Kasamatsu Y, Nakamura T, Motoki M, Kato M, Hattori K, Shibata T, Yamagami K. Endovascular repair of sealed rupture of a thoracic inflammatory aneurysm that developed after corticosteroid therapy. Intern Med 2010; 49:1221-4. [PMID: 20558948 DOI: 10.2169/internalmedicine.49.3214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old man was admitted to our hospital with thoracic back pain and weight loss. Computed tomography revealed inflammatory aortic aneurysm (IAA) of the descending aorta. Sealed rupture of the aneurysm occurred while the patient was under corticosteroid therapy. Endovascular aneurysm repair (EAR) was performed without postoperative complications. Periaortic fibrosis was remarkably decreased three months later while the patient was under prednisolone (20 mg) administration. We believe that EAR could become a practical alternative to open surgical repair. The possibility of an aneurysm rupturing during corticosteroid therapy for IAA should be considered.
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Affiliation(s)
- Tomoko Miyashita
- Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan.
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Paravastu SCV, Ghosh J, Murray D, Farquharson FG, Serracino-Inglott F, Walker MG. A Systematic Review of Open Versus Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2009; 38:291-7. [PMID: 19541509 DOI: 10.1016/j.ejvs.2009.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 05/09/2009] [Indexed: 11/30/2022]
Affiliation(s)
- S C V Paravastu
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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Edmonds RD, Tomaszewski JJ, Jackman SV, Chaer RA. Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture. J Vasc Surg 2008; 48:1332-4. [DOI: 10.1016/j.jvs.2008.05.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 05/12/2008] [Accepted: 05/12/2008] [Indexed: 11/24/2022]
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van Bommel EFH, van der Veer SJ, Hendriksz TR, Bleumink GS. Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature. Vasc Med 2008; 13:293-303. [DOI: 10.1177/1358863x08091147] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract Data on the outcome of aneurysmal chronic peri-aortitis (‘inflammatory aneurysm’) after open surgical aneurysm repair are few and contradictory. To what extent this inflammatory process is reversed after endovascular aneurysm repair (EVAR) is even more unclear. The objective of this review was to study the outcome of peri-aortic fibrosis (PAF) and ureteral obstruction in patients with aneurysmal chronic peri-aortitis treated with open surgery or EVAR. Medical literature was searched for pertinent articles on the outcome of PAF and ureteral obstruction after open surgery or EVAR from 1970 through October 2007. Studies were included if specific follow-up data were available on outcomes of interest. A total of 19 studies were included comprising 478 patients (open surgical, n = 426; EVAR, n = 52). Age, sex and percentage of patients with ureteral obstruction (31% vs 37%) did not differ between groups. Regression of PAF occurred more frequently after open surgery compared to EVAR (86% vs 60%; p < 0.0001). Complete regression of PAF was more frequent after open surgery compared to EVAR (52% vs 14%; p < 0.0001). After excluding patients in whom concurrent ureterolysis was performed, the frequency of persistent ureteral obstruction remained lower in patients treated surgically compared to patients treated with EVAR, albeit not statistically significant (32% vs 56%; p = 0.09). In conclusion, although open surgery is superior to EVAR in achieving regression of chronic peri-aortitis, the frequency of persistent PAF and/or ureteral obstruction is not negligible. Additional medical and/or urological treatment should be considered in selected cases of aneurysmal chronic peri-aortitis.
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Affiliation(s)
- EFH van Bommel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - SJ van der Veer
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - TR Hendriksz
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - GS Bleumink
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Hata H, Toda K, Kainuma S, Taniguchi K. Distal graft anastomosis using a tapered elephant trunk in an inflammatory aneurysm. Ann Vasc Surg 2008; 23:257.e3-5. [PMID: 18809278 DOI: 10.1016/j.avsg.2008.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 05/21/2008] [Accepted: 08/12/2008] [Indexed: 11/29/2022]
Abstract
Graft replacement of an inflammatory abdominal aortic aneurysm is rather troublesome due to the marked adhesion to surrounding organs and thickened wall, which is mostly too hard and inflexible to allow the artery to be fitted to a prosthetic graft. For one such case, we developed a novel and unique technique for a distal anastomosis using a tapered elephant trunk. This technique was designed on the assumption of further aneurysmal changes and enabled us to create a secure anastomosis at the enlarged inflammatory part of the common iliac artery. The distal flow to both the external and internal iliac arteries was well maintained without any complications.
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Affiliation(s)
- Hiroki Hata
- Department of Cardiovascular Surgery, Japan Labour Health and Welfare Organization, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka, Japan.
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Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT. ACTA ACUST UNITED AC 2008; 34:523-6. [DOI: 10.1007/s00261-008-9407-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mieog JSD, Stoot JHMB, Bosch JJ, Koning OHJ, Hamming JF. Inflammatory aneurysm of the common iliac artery mimicking appendicitis. Vascular 2008; 16:116-119. [PMID: 18377843 DOI: 10.2310/6670.2008.00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Isolated inflammatory aneurysm of the common iliac artery is a rare condition. Previously reported cases presented with urologic complications owing to entrapment of the ureter in the perianeurysmal fibrosis. We report a case of a healthy young man who presented with acute abdominal pain in the right lower quadrant without urologic complications mimicking acute appendicitis. The pain was caused by an isolated inflammatory aneurysm of the right common iliac artery measuring 4 cm in diameter. Three years after open aneurysmal resection and graft interposition, the patient is doing well, with excellent peripheral circulation. The available literature on presentation, diagnosis, and treatment is reviewed.
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Affiliation(s)
- J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Sharif MA, Soong CV, Lee B, McCallion K, Hannon RJ. Inflammatory Infrarenal Abdominal Aortic Aneurysm in a Young Woman. J Emerg Med 2008; 34:147-50. [DOI: 10.1016/j.jemermed.2007.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 04/18/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
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Fattori R, Russo V. Endovascular treatment of atherosclerotic and other thoracic aortic aneurysms. Semin Intervent Radiol 2007; 24:197-205. [PMID: 21326796 DOI: 10.1055/s-2007-980043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The incidence of thoracic aortic aneurysms (TAAs) is increasing with the present rate of occurrence at 10.9 cases per 100,000 people per year. The estimated 5-year risk of rupture of a TAA with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms ≥ 6 cm. Despite increasing awareness of the importance of early diagnosis and treatment options, there are no clear guidelines available at the time of writing. Nor is there any clear evidence for specific pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment (EVT), proposed as an alternative to surgery, has been considered a therapeutic innovation, especially because it is minimally invasive, which allows treatment even in high surgical risk patients. Vascular imaging is crucial for patient selection, endoprosthesis choice, and planning of the treatment because not all aneurysms are suitable. Early and midterm results are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of TAAs, many factors must be considered, including the clinical situation, comorbidities, anatomy, choice of equipment, and last, but not less important, experience of the clinical team.
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Affiliation(s)
- Rossella Fattori
- Cardiothoracovascular Department, Cardiovascular Radiology Unit, University Hospital S. Orsola, Bologna, Italy
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