This paper is only available as a PDF. To read, Please Download here.
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 injuries of the bowel
(n = 22), urinary tract system (n = 7), veins (n = 30), pancreas (n = 6), and spleen (n = 5), 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
postoperative 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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Vascular and Endovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
January 5,
2023
Received in revised form:
December 20,
2022
Received:
June 7,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
