Long-term outcome after inflammatory abdominal aortic aneurysm repair: case-matched study

The purpose of this study was to compare early and late outcomes after inflammatory and noninflammatory abdominal aortic aneurysm (AAA) repair with emphasis on graft-related complications. Of 625 consecutive patients submitted to AAA repair, 18 were classified as having inflammatory AAAs (group 1). The results of this group were compared with those of 54 patients (group 2) retrospectively drawn from patients who underwent aortic replacement for noninflammatory AAAs. A computer-assisted matching system was used to match patients according to date of birth, gender, and surgical priority. All patients of both groups were followed by periodic clinical and instrumental examinations. Patients in group 1 complained more frequently of aneurysm-related symptoms (72% vs. 20%; p = 0.0001), and their erythrocyte sedimentation rate was elevated more often (78% vs. 19%; p < 0.0001). Surgical morbidity and mortality rates were not different. The mean lengths of follow-up were 61 +/- 47 months (group 1) and 71 +/- 38 months (group 2). The 10-year overall survival rates did not differ significantly between the two groups (49.1% +/- 16.9% for group 1 vs. 61.6% +/- 13.8% for group 2; p = 0.26, log-rank test). In contrast, the free from paraanastomotic aneurysm survival rates were significantly lower in group 1 (57.3% +/- 20.2% vs. 97.8% +/- 2.5% at 10 years; p = 0.025, log-rank test). Long-term outcomes showed a higher incidence of graft-related complications in group 1. As inflammatory aneurysms might represent a risk factor for the development of paraanastomotic aneurysms, routine imaging surveillance of graft aortic healing after inflammatory AAA repair is warranted.