Robert J Hinchliffe1, Jan A Macierewicz, Brian R Hopkinson. 1. Department of Vascular and Endovascular Surgery, E Floor, West Block, University Hospital, Derby Road, Nottingham NG7 2UH, England, UK. robhinchliffe@hotmail.com
Abstract
PURPOSE: To report a single-center experience with endovascular repair of inflammatory abdominal aortic aneurysm (IAAA), with particular attention to the fate of the aneurysm sac, perianeurysmal fibrosis (PAF), and renal function. METHODS: A retrospective review of 350 patients undergoing endovascular aortic aneurysm repair during a 7-year period at University Hospital, Nottingham, identified 14 (4%) cases of IAAA confirmed either on preoperative spiral computed tomography (CT) or at laparotomy in attempted open aneurysm repair. All data were reviewed from a prospectively maintained database, hospital notes, and serial CT studies. RESULTS: Endovascular repair was successfully completed in all 14 IAAA patients, but 2 (14%) died in the perioperative period. One patient referred from another center was lost to imaging follow-up, leaving 11 patients who were followed for a mean 29 months (range 1-73). All 11 IAAAs remained excluded, but 1 patient required a secondary transabdominal intervention for a type III endoleak. There was no CT evidence of PAF progression in any patient. Postoperative renal complications were not encountered where there had been none preoperatively. CONCLUSIONS: IAAA may be successfully excluded by the endovascular technique, and EVAR is particularly useful where open repair has failed. The impact of endograft placement on perianeurysmal fibrosis is less clear. In this study, there was no suggestion that the degree of PAF worsens following endovascular repair.
PURPOSE: To report a single-center experience with endovascular repair of inflammatory abdominal aortic aneurysm (IAAA), with particular attention to the fate of the aneurysm sac, perianeurysmal fibrosis (PAF), and renal function. METHODS: A retrospective review of 350 patients undergoing endovascular aortic aneurysm repair during a 7-year period at University Hospital, Nottingham, identified 14 (4%) cases of IAAA confirmed either on preoperative spiral computed tomography (CT) or at laparotomy in attempted open aneurysm repair. All data were reviewed from a prospectively maintained database, hospital notes, and serial CT studies. RESULTS: Endovascular repair was successfully completed in all 14 IAAA patients, but 2 (14%) died in the perioperative period. One patient referred from another center was lost to imaging follow-up, leaving 11 patients who were followed for a mean 29 months (range 1-73). All 11 IAAAs remained excluded, but 1 patient required a secondary transabdominal intervention for a type III endoleak. There was no CT evidence of PAF progression in any patient. Postoperative renal complications were not encountered where there had been none preoperatively. CONCLUSIONS: IAAA may be successfully excluded by the endovascular technique, and EVAR is particularly useful where open repair has failed. The impact of endograft placement on perianeurysmal fibrosis is less clear. In this study, there was no suggestion that the degree of PAF worsens following endovascular repair.