[Approach to juxtarenal inflammatory aneurysms]

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Pathogenesis
• Inflammatory Diseases

Context:

• Inflammatory abdominal aortic aneurysm (IAAA) constitutes 2-15% of aortic aneurysms, frequently occurring in juxtarenal or infrarenal locations.
• The exact ethopathogenesis of IAAA remains uncertain, with current hypotheses suggesting a shared autoimmune inflammatory pathway with atherosclerotic aneurysms.
• Common clinical presentations include abdominal/lumbar pain, weight loss, and elevated C-reactive protein, with a high propensity for rupture.

Purpose:

• To review the current understanding of IAAA's incidence, ethopathogenesis, clinical presentation, and diagnostic modalities.
• To evaluate the surgical indications and preferred treatment approaches for IAAA, including comparisons between open and endovascular techniques.
• To highlight the advantages of the retroperitoneal approach for juxtarenal IAAA and discuss the current limitations of endovascular repair.

Summary:

• IAAA diagnosis is supported by imaging (CT, MRI) with ~90% accuracy and confirmed histologically.
• Surgical intervention for IAAA is recommended similarly to atherosclerotic aneurysms, driven by improved minimally invasive techniques and reduced perioperative risks.
• The retroperitoneal approach is favored for juxtarenal IAAA due to better aortic exposure and fewer complications compared to transperitoneal methods; endovascular options are currently limited.

Impact:

• Advances in diagnostic and surgical techniques have improved outcomes for IAAA patients.
• The retroperitoneal approach offers significant advantages for treating juxtarenal IAAA.
• Further research into endovascular repair, potentially with novel endografts, may expand future treatment options for IAAA.