Inflammatory abdominal aortic aneurysms.

Abstract

BACKGROUND: Inflammatory abdominal aortic aneurysms (IAAA) are a variant of aortic aneurysm characterised by extensive peri-aneurysmal fibrosis, thickened walls and dense adhesions and represent between 3 and 10% of all abdominal aortic aneurysms (AAA). Surgery is technically challenging and is still associated with an increased morbidity and mortality. Controversy exists about aetiology and pathogenesis. METHODS: We review the literature on the current theories, the available imaging modalities and the current thinking on management of IAAA. A Medline database search was performed. Articles were cross-referenced. RESULTS AND CONCLUSIONS: Aneurysm development is multifactorial with important genetic and environmental factors. The literature supports the theory that IAAA arise from the same antigenic stimulus that is responsible for the non-IAAA, representing one extreme of an inflammatory spectrum. The results after open repair have improved and there is now little difference in the mortality between non-IAAA and IAAA repair. However, there is likely to be a role for endovascular stenting in IAAA management and this requires further study. It is clear that closer follow-up of patients after IAAA repair with either technique is necessary to monitor the inflammatory process. No evidence-based follow-up protocol exists but three to six-monthly monitoring of renal function and erythrocyte sedimentation rate (ESR) for 24 months post-repair would seem a reasonable regime.