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Chirurgia 2019 December;32(6):352-5

DOI: 10.23736/S0394-9508.18.04945-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Thrombosis of small abdominal aortic inflammatory aneurysm

Marco LEOPARDI, Alessia SALERNO , Ludovico PERILLI, Pietro SCARPELLI, Marco VENTURA

Unit of Vascular Surgery, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy



We describe a case of inflammatory aortic aneurism, which presented with acute aortic thrombosis and lower limbs ischemia. Few series of inflammatory aneurysms are described in literature and in the best of our knowledge no cases of acute thrombosis are described. A 69-year-old man presented at the emergency room at our hospital for abdominal pain, associated with significant weight loss and left gluteal claudication. A CT-scan showed a fusiform small aortic aneurysm, which extended to the proximal tract of the left common iliac artery, determining partial occlusion, and irregular vascularized parietal thickening of the abdominal aorta. After a few weeks he went back to the emergency room, a new CT-scan showed aneurysm and left common iliac artery occlusion. Patient was urgently addressed to aortic reconstruction with aorto-iliac bypass. A control scan 10 days after intervention showed a periprosthetic liquid collection, which was drained percutaneously and patient was discharged on eighteenth postoperative day. Histology from aortic sample showed a chronic sclerotic aortitis IgG4 positive. One-month control scan showed graft patency and reduction of periaortic fibrosis. Inflammatory aneurysms represent an uncommon condition; thrombosis of aorta in those patients is rare and unexpected. In this case an endovascular repair was not feasible due acute occlusion and pathologic iliac arteries and open repair was the only therapeutic option available in our experience. Etiology of acute thrombosis remains unclear but stenosis of common iliac arteries may be responsible of blood flow deceleration and consequent thrombosis.


KEY WORDS: Aortic aneurysm; Fibrosis; Thrombosis; Immunoglobulin G4-related disease

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