Endovascular Repair of Inflammatory Aortic Aneurysms: Experience in a Single Center.

BACKGROUND: Inflammatory abdominal aortic aneurysm (IAAA) remained a rare cause of aneurysmal aortic disease, with incidences between 5% and 10%. The current treatment for IAAA consists of open surgical repair and endovascular aneurysm repair (EVAR). Avoiding an inflamed, fibrotic retroperitoneum is the driving force behind the desire to repair IAAA endovascularly. The latest published works confirm the promising results after EVAR for IAAA, but there is still a paucity of data regarding hydroureter and hydronephrosis. In this article, we describe our experience with 5 patients diagnosed with IAAA and treated by EVAR, of whom 3 presented with associated hydronephrosis. METHODS: A retrospective review of our endovascular database identified five patients who underwent EVAR for IAAA. Unilateral ureteral involvement in the inflammatory process was seen in 3 patients, accompanied by secondary hydronephrosis. One patient presented retroperitoneal fibrosis with duodenal stenosis. Primary outcomes were primary technical success, aneurysm-related mortality, change in aneurysm size, perianeurysmal fibrosis (PAF), and hydronephrosis. Secondary outcomes were requirement for reintervention, progression/resolution of symptoms, and short-term clinical success. RESULTS: Follow-up duration ranged from 3 to 61 months. No patients were lost to follow-up. Primary technical success was obtained in all patients. One patient died three months after the operation due to persistence of the duodenal stenosis in spite of subsequent endoscopic treatments and corticotherapy. The aneurysm sac progressively reduced in 4 patients and remained unchanged in one patient. PAF regressed in 2 patients, reduced in two, and remained unchanged in one patient. Hydronephrosis persisted in all three patients preoperatively diagnosed with this condition. No patient required subsequent intervention. Four patients had complete resolution of their symptoms at a follow-up visit at 1 month. CONCLUSIONS: This series suggests that EVAR for IAAA is technically feasible, excludes the aneurysm effectively, and reduces PAF with an acceptable morbidity and mortality rate. EVAR does not seem to offer any benefits for hydronephrosis, and closer follow-up in patients presenting renal or ureter involvement treated by EVAR is necessary.

Mycotic aortic aneurysms treated by endovascular repair: initial experience in a single center.

INTRODUCTION: Mycotic aortic aneurysm (MAA) is an uncommon cause of aneurysmal aortic disease. However, it may have an aggressive presentation and a complicated early outcome. Endovascular aneurysm repair (EVAR) of MAA is emerging as an alternative to open repair (OR) for the treatment of these aneurysms, particularly in high-risk surgical patients. We report a single-center experience with the endovascular management of mycotic aortic aneurysms. MATERIAL AND METHODS: Two mycotic abdominal aortic aneurysms were treated with an endovascular stent graft at Centre Hospitalier Régional du Val de Sambre, Belgium. The mean follow-up was 15 months. Technical success was achieved in all two patients. CT-scan follow up showed shrinkage of the aneurysm sac, with no evidence of infection along the stent graft and no signs of endoleakage in all patients. One patient died during the follow-up period from a cause unrelated to the aneurysm. CONCLUSION: EVAR is an effective and safe option and might be a suitable alternative to OR in the absence of predictors of poor prognosis for the treatment of non-complicated forms of MAA.

Multidisciplinary management of testicular cancer complicated by thrombosis of the inferior vena cava: a case report.

INTRODUCTION: Testicular cancer is a rare disease, most commonly seen in young adults. It represents 1% of solid cancers in men. Inferior vena cava (IVC) thrombosis remains a rare complication of testicular cancer and is often associated with a high risk of pulmonary embolism (PE). CASE REPORT: The authors report a case of a 26-year-old man presenting with advanced testicular cancer, left-sided retroperitoneal metastasis and parietal infiltration of the IVC complicated with thrombosis of the left iliac vein and the IVC, both responsible for PE. DISCUSSION: A multidisciplinary management which included curative excision of the lesions, placement of a temporary IVC filter and adjuvant chemotherapy permitted an optimal approach. No complications occurred and the post-operative healing was uneventful. No recurrences were observed on the long-term follow-up. CONCLUSIONS: IVC Thrombosis is a rare complication that should be taken into consideration when diagnosing testicular cancer. Prompt diagnosis is crucial to minimize the risk of PE which can be life-threatening.