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The Journal of Cardiovascular Surgery 1999 June;40(3):407-412

language: English

Inflam­ma­tory aneu­rysm of the abdo­minal ­aorta. A pros­pec­tive clin­ical ­study

Di Marzo L., Sapienza P., Bernucci P.*, Gallo P.*, Tedesco M., Cavallaro A.

From the 1st Depart­ment of Sur­gery and *­Pathology Uni­ver­sity of ­Rome "La ­Sapienza", ­Rome, ­Italy


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Objec­tive. ­This ­study was under­taken to inves­ti­gate a con­sec­u­tive ­series of abdom­inal ­aortic aneu­rysm ­studied ­with his­tology to high­light the eti­ology, the inci­dence, the ­value of pre­op­er­a­tive ­studies and intra­op­er­a­tive find­ings.
Experi­mental ­design. Pros­pec­tive ­study.
Set­ting. Uni­ver­sity hos­pital.
­Patients. ­Between 1992 and 1994, 102 ­patients under­went elec­tive sur­gical ­repair of an abdom­inal ­aortic aneu­rysm. The ­patients ­were pros­pec­tively ­divided as ­having an inflammatory aneurysm (IA) or an ath­e­ros­cle­rotic aneu­rysm (AA) on the ­basis of pre­op­er­a­tive and intra­op­er­a­tive find­ings. Fur­ther his­to­log­ical eval­u­a­tion ­assigned the ­patients to one of the two ­groups.
­Results. The inci­dence of IA was 15%. ­Overall, symp­toms, CT ­scan ­studies, aneu­rysmal ­wall thick­ness, ­white glis­tening per­i­aneu­rysmal ­fibrosis, ­bleeding ­from the aneu­rysmal ­wall and adhe­sion to the duod­enum diag­nosed 11 (73%) ­cases of IA. His­tology ­showed ­that a gran­u­lom­a­tous reac­tion ­against ­some com­po­nents of the ath­e­ros­cle­rotic ­plaques ­resulting in an ­auto-­allergic ­response to ­this com­po­nent ­could ­initiate the inflam­ma­tory pro­cess ­thus ­resulting in a pro­gres­sive adven­ti­tial and per­i­-ad­ven­ti­tial ­fibrosis ­with inflam­ma­tion, lym­phad­e­nitis and lym­phatic dil­a­ta­tion.
Con­clu­sions. Pre­op­er­a­tive and intra­op­er­a­tive find­ings under­es­ti­mate the inci­dence of IA. ­Aortic resec­tion can pre­vent the pro­gres­sion of the inflam­ma­tory pro­cess and the com­pli­ca­tions usu­ally ­observed ­when the expo­sure to the ­allergen deter­mines an involve­ment of the per­i­aortic struc­tures.

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