Surgical Treatment of Inflammatory Abdominal Aortic Aneurysms: Outcome and Predictors Analysis

Overview

Journal Med Arch

Specialty General Medicine

Date 2015 Jan 9

PMID 25568545

Authors

Edmond Nuellari

Edvin Prifti

Giampiero Esposito

Edmond Kapedani

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study is to report our experience on the postoperative outcome of surgical treatment of inflammatory abdominal aortic aneurysm (IAAA).

Materials And Methods: Between 1997-2014, 35 patients with IAAA underwent surgery. The mean age was 63+/-18years. Chronic renal failure was identified in 11(31.4%)patients and confirmed ischemic heart disease in 15(43%)patients. The mean aortic aneurysm diameter was 68+/-25mm. The abdominal aorta was clamped above the renal arteries in 6 (17%) patients.

Results: The hospital mortality was 5.7% (2 patients). Three patients developed an aortic pseudoaneurysm and underwent a redo operation. Another patient developed a femoral anastomotic pseudoaneurysm 7 years after operation and he was treated surgically. The actuarial free-reoperation actuarial survival at 1, 5 and 7 years was 94%, 62% and 50% respectively. The Cox model revealed the delta ESR (p=0.002), ischemic heart disease (p=0.006) and renal failure (p=0.036) as strong predictors for poor overall outcome.

Conclusion: Early postoperative outcome in terms of mortality and morbidity seems acceptable, however patients with IAAA have an increased risk for reoperation due to pseudonaneurysm formation. Strong predictors for poor overall outcome seems to be the elevated erythrocyte sedimentation rate, ischemic heart disease and chronic renal failure.

References

Nagahama H, Nakamura K, Matsuyama M, Endou J, Nishimura M, Ishii H . Inflammatory abdominal aortic aneurysm: report of seven cases. Ann Vasc Dis. 2014; 6(4):756-8. PMC: 3866370. DOI: 10.3400/avd.cr.13-00079. View

Yusuf K, Murat B, Unal A, Ulku K, Taylan K, Ozerdem O . Inflammatory abdominal aortic aneurysm: predictors of long-term outcome in a case-control study. Surgery. 2006; 141(1):83-9. DOI: 10.1016/j.surg.2006.04.007. View

Rose A, Dent D . Inflammatory variant of abdominal atherosclerotic aneurysm. Arch Pathol Lab Med. 1981; 105(8):409-13. View

Bonati L, Rubini P, Japichino G, Parolari A, Contini S, Zinicola R . Long-term outcome after inflammatory abdominal aortic aneurysm repair: case-matched study. World J Surg. 2003; 27(5):539-44. DOI: 10.1007/s00268-003-6706-4. View

Iino M, Kuribayashi S, Imakita S, Takamiya M, Matsuo H, Ookita Y . Sensitivity and specificity of CT in the diagnosis of inflammatory abdominal aortic aneurysms. J Comput Assist Tomogr. 2002; 26(6):1006-12. DOI: 10.1097/00004728-200211000-00026. View

West A, Ryan P, OBriain D, Keane F . Inflammatory aortic aneurysm: report of a case suggesting athero-ischaemic aetiology. J Cardiovasc Surg (Torino). 1988; 29(2):213-5. View

Stella A, Gargiulo M, Faggioli G, Bertoni F, Cappello I, Brusori S . Postoperative course of inflammatory abdominal aortic aneurysms. Ann Vasc Surg. 1993; 7(3):229-38. DOI: 10.1007/BF02000247. View

Mitchinson M . Chronic periaortitis and periarteritis. Histopathology. 1984; 8(4):589-600. DOI: 10.1111/j.1365-2559.1984.tb02371.x. View

Lindblad B, Almgren B, Bergqvist D, Eriksson I, Forsberg O, Glimaker H . Abdominal aortic aneurysm with perianeurysmal fibrosis: experience from 11 Swedish vascular centers. J Vasc Surg. 1991; 13(2):231-7; discussion 237-9. DOI: 10.1067/mva.1991.25583. View

10.

Walker D, Bloor K, Williams G, Gillie I . Inflammatory aneurysms of the abdominal aorta. Br J Surg. 1972; 59(8):609-14. DOI: 10.1002/bjs.1800590807. View

11.

Cenacchi G, Guiducci G, Pasquinelli G, Gargiulo M, Degani A, Stella A . The morphology of elastin in non-specific and inflammatory abdominal aortic aneurysms. A comparative transmission, scanning and immunoelectronmicroscopy study. J Submicrosc Cytol Pathol. 1995; 27(1):75-81. View

12.

Hertzer N, Mascha E, Karafa M, OHara P, Krajewski L, Beven E . Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. J Vasc Surg. 2002; 35(6):1145-54. DOI: 10.1067/mva.2002.123686. View

13.

Vaglio A, Greco P, Corradi D, Palmisano A, Martorana D, Ronda N . Autoimmune aspects of chronic periaortitis. Autoimmun Rev. 2006; 5(7):458-64. DOI: 10.1016/j.autrev.2006.03.011. View

14.

Yonemitsu Y, Nakagawa K, Tanaka S, Mori R, Sugimachi K, Sueishi K . In situ detection of frequent and active infection of human cytomegalovirus in inflammatory abdominal aortic aneurysms: possible pathogenic role in sustained chronic inflammatory reaction. Lab Invest. 1996; 74(4):723-36. View

15.

Tambyraja A, Murie J, Chalmers R . Ruptured inflammatory abdominal aortic aneurysm: insights in clinical management and outcome. J Vasc Surg. 2004; 39(2):400-3. DOI: 10.1016/j.jvs.2003.07.029. View

16.

Johnston K, Rutherford R, Tilson M, Shah D, Hollier L, Stanley J . Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for.... J Vasc Surg. 1991; 13(3):452-8. DOI: 10.1067/mva.1991.26737. View

17.

Yin M, Zhang J, Wang S, Duan Z, Xin S . Inflammatory abdominal aortic aneurysm: clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm. Chin Med J (Engl). 2010; 123(10):1255-8. View

18.

Nitecki S, Hallett Jr J, W Stanson A, Ilstrup D, Bower T, Cherry Jr K . Inflammatory abdominal aortic aneurysms: a case-control study. J Vasc Surg. 1996; 23(5):860-8; discussion 868-9. DOI: 10.1016/s0741-5214(96)70249-5. View

19.

Biancari F, Ylonen K, Anttila V, Juvonen J, Romsi P, Satta J . Durability of open repair of infrarenal abdominal aortic aneurysm: a 15-year follow-up study. J Vasc Surg. 2002; 35(1):87-93. DOI: 10.1067/mva.2002.119751. View

20.

McMahon J, Davies J, Scott D, Tennant W, Powell J, Hughes A . The microscopic features of inflammatory abdominal aortic aneurysms: discriminant analysis. Histopathology. 1990; 16(6):557-64. DOI: 10.1111/j.1365-2559.1990.tb01160.x. View