Journal article
Multidisciplinary Diagnosis and Management of Inflammatory Aortic Aneurysms
Journal of vascular surgery, Vol.78(1), pp.231-242.e2
07/2023
DOI: 10.1016/j.jvs.2022.12.024
PMID: 36565773
Abstract
Inflammatory abdominal aortic aneurysm (IAAA) is a variant involving a distinct immuno-inflammatory process, with nearly half believed to be associated with IgG4-related disease (IgG4-RD).
MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms since January 1970. Search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant publications were selected for review based on their relevance.
Morphologically, IAAA are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on
FDG -PET imaging. There is strong association with peri-aneurysmal and retroperitoneal fibrosis. Although rupture risk appears lower in IAAA compared to non-inflammatory aneurysms, the currently recommended diameter threshold for operative management is the same. Open repair is associated with increased morbidity compared to non-inflammatory AAA, and a retroperitoneal approach or otherwise a minimal dissection transperitoneal approach are recommended to avoid duodenal or retroperitoneal structure injury. Endovascular aneurysm repair (EVAR) is being used increasingly especially in patients unfit for surgery. It is important to exclude an infectious etiology prior to initiation of immunosuppressive therapy or proceeding with operative repair. Multi-modality imaging followup is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed post-operatively in most patients with active systemic disease, especially IgG4-RD and in those with persistent symptoms. Additional interventions aimed at ureteral decompression may also be needed and lifelong followup is mandatory.
Pre-operative multimodality imaging is a diagnostic cornerstone for assessment of disease extent and activity. IgG4-RD is an increasingly recognized category of IAAA, with implications on tailoring adjunct medical therapy. Open surgical repair remains the procedure of choice, although EVAR is increasingly being offered. Maintenance immunosuppressive therapy can be offered based on disease activity as assessed on followup imaging.
Details
- Title: Subtitle
- Multidisciplinary Diagnosis and Management of Inflammatory Aortic Aneurysms
- Creators
- Jun Xu - Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. Electronic address: jun-xu-1@uiowa.eduBrittany Bettendorf - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. Electronic address: brittany-bettendorf@uiowa.eduMario D'Oria - Consultant Vascular and Endovascular Surgeon, Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy. Electronic address: mario.doria88@outlook.comMel J Sharafuddin - Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. Electronic address: mel-sharafuddin@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Journal of vascular surgery, Vol.78(1), pp.231-242.e2
- DOI
- 10.1016/j.jvs.2022.12.024
- PMID
- 36565773
- eISSN
- 1097-6809
- Language
- English
- Electronic publication date
- 12/21/2022
- Date published
- 07/2023
- Academic Unit
- Radiology; Surgery; Immunology; Internal Medicine
- Record Identifier
- 9984353496202771
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