ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2001 December;8(4):275-83

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English, Italian

Inflammatory aneurysms of the abdominal aorta

Bajardi G., Talarico F., Ricevuto G., Calì F.

From the Department of Vascular Surgery University of Palermo

Back­ground. The aim of ­this ­study was to ­report our expe­ri­ence of a pathol­o­gy ­that is diag­nosed ­with increas­ing fre­quen­cy: inflam­ma­to­ry aneu­rysms of the abdom­i­nal aor­ta (­IAAA).
Meth­ods. We ­report our expe­ri­ence of 5 cas­es ­observed dur­ing ­between Novem­ber 1999 and Novem­ber 2000 (10% of all AAA ­observed dur­ing the ­same peri­od). Two ­patients ­were under­went emer­gen­cy sur­gery fol­low­ing ­IAAA rup­ture. All ­patients under­went ECO (in elec­tion) and CAT ­with con­trast medi­um. A pre­op­er­a­tive diag­no­sis of ­IAAA was ­made in 3 out of 5 cas­es (60%). ­Left hydro­ure­ter­o­neph­ro­sis was ­present in 1 ­case (20%). All ­patients under­went sur­gery ­using trans­per­it­o­neal ­access.
­Results. Post­op­er­a­tive mor­tal­ity was ­zero. The ­main com­pli­ca­tion was 1 ­case (20%) of pan­crea­titis ­which ­regressed with med­i­cal treat­ment. Cor­ti­sone treat­ment was asso­ciat­ed in all cas­es for 2 ­months.
Con­clu­sions. The pathog­e­net­ic mech­a­nisms of ­IAAA are dis­cussed. The impli­ca­tions of sur­gi­cal treat­ment are ana­lysed (trans­per­it­o­neal vs ret­ro­per­i­to­neal ­access), (endo­vas­cu­lar treat­ment vs ­open sur­gery) (oppor­tu­nity for sur­gi­cal pro­ce­dures involv­ing oth­er ­organs). The ­study under­lines the impor­tance of pre­op­er­a­tive diag­no­sis as a ­means of plan­ning all the phas­es of treat­ment (treat­ment of ­IAAA, provoke of ret­ro­per­i­to­neal fibro­sis (FR), antiph­lo­gis­tic treat­ment). ­Although ­IAAA provoke an ­increase in post­op­er­a­tive mor­bid­ity and mor­tal­ity, a care­ful sur­gi­cal prep­ar­a­tion ­with min­i­mal dis­sec­tion and ­remote clamp­ing rep­re­sents the ­best pro­phy­lax­is of com­pli­ca­tions. ­IAAA ­require scru­pu­lous fol­low-up in ­order to mon­i­tor the evo­lu­tion of FR and reg­u­late any asso­ciat­ed med­i­cal treat­ment ­required.