Novel Management of Peri-Aortitis after Endovascular Repair of Abdominal Aortic Aneurysm

Periaortitis post endovascular aortic aneurysm repair (EVAR) represents a very rare complication, described only in 10 cases between 2001 and 2023. It may appear early or late after EVAR and the majority of patients had ureter compression, and all patients were treated with high dose of corticosteroids, with a complete resolution of symptoms except for one patient. We report a literature review and a case of early post-EVAR periaortitis manifested with acute renal failure due to ureter compression, treated with urgent bilateral J stent and high dose of corticosteroid, with complete resolution of symptoms. Clinical Impact Even if periaortitis secondary to EVAR is a very rare complication, it is important for the surgeon to know this possible rare complication and its characteristics, in order to immediately recognize it and treat it adequately to avoid complications.

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Periaortitis Following Endovascular Aneurysm Repair – A Case Report and Review of Literature

Dhanpal,

Raj,

Motukuru

et al. 2023

Indian Journal of Vascular and Endovascular Surgery

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Endovascular aneurysm repair (EVAR) is a minimally invasive well-described procedure used in the management of infrarenal abdominal aortic aneurysms (AAA). Periaortitis following EVAR is a rare but possible complication that must be considered during surveillance. We recount a case of a 77-year-old man who underwent an EVAR with coiling of the right internal iliac artery for an incidentally detected inflammatory AAA. Due to intractable lower back ache, fatigue, and low-grade fever that surfaced a month postoperatively, he was evaluated with inflammatory markers, Positron emission tomography-computed tomography angiograms which revealed features of periaortic inflammation and involvement of the right ureter and duodenum. He was managed with broad-spectrum antibiotics to which he responded albeit transiently. Persistent symptoms prompted us to start systemic corticosteroids as per body weight that was tapered over 2 months and ureteric stenting was offered. Management with corticosteroids, tamoxifen, and early stenting has been described in the reported literature. His symptoms improved dramatically and the evidently high inflammatory markers also reduced. Keen monitoring and early management with steroids of periaortitis following EVAR is a prudent paradigm to be implemented.

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Novel Management of Peri-Aortitis after Endovascular Repair of Abdominal Aortic Aneurysm

Cited by 4 publications

References 13 publications

Multidisciplinary diagnosis and management of inflammatory aortic aneurysms

Multidisciplinary diagnosis and management of inflammatory aortic aneurysms

Periaortitis Secondary to Evar: Case Report and Literature Review

Periaortitis Following Endovascular Aneurysm Repair – A Case Report and Review of Literature

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