Inflammatory Abdominal Aortic Aneurysms, 3 Cases

ABSTRACT

An inflammatory abdominal aortic aneurysm (IAAA) is a unique abdominal aortic aneurysm (AAA) subtype, which shows severe inflammatory adhesion to adjacent structures. An IAAA is usually symptomatic; back pain, hydronephrosis, fever and weight loss are common manifestations. Recently, the operative mortality of IAAAs has been reported as being indifferent from that of non-inflammatory AAAs. However, as the technical difficulty of the operation is directly related to the complications and mortality, the operation for an IAAA is usually challenging to the vascular surgeons. Herein, we present our experience of three IAAA patients, who were successfully treated by surgical repairs. Cases: The 1st patient was a 62-year-old male with severe back pain and 8 kg of weight loss over a 3-month period. The IAAA was diagnosed by a CT scan. A Dacron Y graft was successfully placed via a retroperitoneal approach. After the operation, his back pain had been completely resolved. The 2nd and 3rd patients were 71 and 67-year-old males with left flank pain. The preoperative CT scans showed infrarenal IAAAs, with hydronephrosis of left kidney and ureter. After placing a ureteral catheter through the cystoscope, the aneurysms were repaired using Dacron Y-grafts via a transperitoneal approach. After the operations, the symptoms of these two patients completely disappeared. The 2nd patient showed complete resolution of the perianeurysmal inflammation and hydronephrosis on a follow up CT scan four months after surgery. The 3rd patient's hydronephrosis had not resolved on the follow up ultrasonogram two months after the surgery, but he was symptom free. All three patients are doing well at the 16th, 8th and 3rd postoperative months.