Inflammatory aneurysms of the abdominal aorta: Incidence, pathologic, and etiologic considerations

Abstract

Among 486 patients undergoing repair for abdominal aortic aneurysm (AAA) during a 12-year period, 30 (6.2%) had evidence of "inflammatory" AAA. One patient (3%) had acute rupture, and six patients (20%) had chronic contained rupture. Ureteral obstruction was evident in 20% of the patients. In the early period of the study there were two postoperative deaths and operative time and blood loss were significantly increased. In the last period of the study, no attempt was made to separate the duodenum and the ureters from the aneurysm; there was no operative mortality, and operative time and blood loss were similar to that of patients with atherosclerotic aneurysms. In 23 of 100 specimens of atherosclerotic AAA, microscopic findings resembling inflammatory AAA were found. On the basis of our study we conclude the following: (1) Inflammatory AAAs are simply atherosclerotic aneurysms that show an unusual accentuation of the chronic inflammation observed in relation to atherosclerotic aneurysms. (2) Operative technique should be modified to avoid excessive dissection and lysis of ureters and duodenum. (3) Excellent early and late results can be expected with proper surgical technique. (4) The causes of AAA are multiple, and chronic contained rupture of the aneurysm and reactive lymphatic hyperplasia might play a role of greater significance than previously thought.

Long‐term Outcome after Inflammatory Abdominal Aortic Aneurysm Repair: Case‐matched Study

“…It should be noted that the number of patients in this study is fairly small because of the strict criteria adopted to define the inflammatory AAA; our prevalence is in fact relatively low (2.8%) compared with other previously reported experiences [2,3,7,8,17]. However, the selection procedure allowed us to obtain two groups with similar preoperative risk factors followed by periodic instrumental examination and to make the groups strictly comparable.…”

“…Some reports showed regression after graft repair in almost all patients, [6,7,10,17,26], whereas more recent studies have shown partial or no regression of the fibrotic process [11][12][13]15]. Certainly, the length and the methods of follow-up vary among papers, and some observations are sporadic.…”

“…Imaging follow-up studies of graftrelated complications in comparison with those of noninflammatory AAAs have rarely been reported [14][15][16]. Some experiences using a clinical follow-up examination showed no significant differences in long-term survival rates between inflammatory and noninflammatory AAAs [6,7,16,17].…”

Inflammatory Abdominal Aortic Aneurysm Followed by Disseminated Intravascular Coagulation and Immune Thrombocytopenia.

“…Adherence of surrounding visceral structures, the ureter, duodenum, vena cava, and renal veins to the periaortic inflammatory mass are characteristics of the IAAA, and patients frequently complain of back or flank pain (1-5). Histopathologically there is a chronic inflammation of connective tissues with infiltrates of lympho- cytes and plasma cells (1,5,13). The disease should be differentiated from idiopathic retroperitoneal fibrosis (IRF) ( 1 2, 14).…”

“…The incidence of the disease among aortic aneurysms ranges from 2 to 15% (3)(4)(5)(6)(7)(8)(9). Weencountered a patient with IAAAwho had disseminated intravascular coagulation (DIC) and immune thrombocytopenic purpura (ITP).…”