REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2018 March;25(1):50-7

DOI: 10.23736/S1824-4777.17.01319-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Current management of inflammatory abdominal aortic aneurysms: a systematic review

Mirko MENEGOLO ✉, Elda C. COLACCHIO, Michele PIAZZA, Michele ANTONELLO, Franco GREGO

Section of Vascular and Endovascular Surgery, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy

INTRODUCTION: Inflammatory abdominal aortic aneurysms (IAAA) account for 2.2-18.1% of all abdominal aortic dilatative diseases. Etiology is not fully defined and still controversial, as well as the best treatment. In this review we summarize current knowledge about etiology, diagnosis and new evidences regarding medical and surgical strategies.
EVIDENCE ACQUISITION: Articles were found via PubMed and library resources and integrated with the author’s knowledge in this field. We examined chapters of books, clinical reviews reporting current management of IAAA, case-control studies, observational studies and retrospective reviews.
EVIDENCE SYNTHESIS: The discovery of IAAA is relatively recent. The definitive etiology remains controversial. Nowadays many authors focus on an autoimmune response against components of the atheroma with the development of a humoral inflammatory reaction. Open surgery has always been the treatment of choice despite the higher technical difficulties, especially in case of emergency. In the endovascular era also, inflammatory aortic aneurysms, can be treated; however, large scale randomized controlled trials are needed.
CONCLUSIONS: Endovascular repair has shown good results in terms of mortality and symptoms regression in the short-term follow-up and it has the potential to be the first-choice treatment in case of aortic rupture. However, regression of periaortic fibrosis results lower in comparison with open repair if the follow-up is extended.

KEY WORDS: Abdominal aortic aneurysm - Retroperitoneal fibrosis - Endovascular procedures - Etiology