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

Abstract

Abstract. The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those of 54 patients (group 2) retrospectively drawn from patients who underwent aortic replacement for noninflammatory AAAs. A computerassisted matching system was used to match patients according to date of birth, gender, and surgical priority. All patients of both groups were followed by periodic clinical and instrumental examinations. Patients in group 1 complained more frequently of aneurysm-related symptoms (72% vs. 20%; p = 0.0001), and their erythrocyte sedimentation rate was elevated more often (78% vs. 19%; p < 0.0001). Surgical morbidity and mortality rates were not different. The mean lengths of follow-up were 61 ± 47 months (group 1) and 71 ± 38 months (group 2). The 10-year overall survival rates did not differ significantly between the two groups (49.1% ± 16.9% for group 1 vs. 61.6% ± 13.8% for group 2; p = 0.26, log-rank test). In contrast, the free from paraanastomotic aneurysm survival rates were significantly lower in group 1 (57.3% ± 20.2% vs. 97.8% ± 2.5% at 10 years; p = 0.025, log-rank test). Long-term outcomes showed a higher incidence of graft-related complications in group 1. As inflammatory aneurysms might represent a risk factor for the development of paraanastomotic aneurysms, routine imaging surveillance of graft aortic healing after inflammatory AAA repair is warranted.

Open Versus Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

“…Anastomotic pseudoaneurysms were not seen after OSR in our study, an additional reason that is thought to favor EVAR and not OSR. 20 Our study has certain limitations. Its retrospective nature and the lack of imaging in patients after OSR reduce the value of our conclusions; additionally during the early years, only OSR (n ¼ 4) was feasible, and there has been a steady increase in favor of EVAR throughout the study period.…”

Long-term Outcome Of Operated Inflammatory Aortic Aneurysms

“…10 In our own patients, despite long followup intervals of up to 10 years, no para-anastomotic aneurysms could be detected. Of the 33 patients who were still alive, we could acquire 64% for the follow-up investigation; the other 12 patients refused the imaging.…”

Chronic periaortitis

“…Aneurysmal exclusion is the principle behind surgery and is aimed at reduction of the inflammatory response and prevention of rupture. With improved surgical techniques, the operative mortality for elective aneurysm repair is as low as 0.9-5% [70] and survival is similar to that of the noninflammatory type [71]. Open repair has been the traditional method, though more recently a transfemoral endoluminal technique using endoprosthesis has been tried successfully [72,73].…”