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Complete aortic replacement in aortitis due to aseptic abscess syndrome
Aurélien Hostalrich1, Jean Porterie2, Jean Baptiste Ricco3
1Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France.
Summary
A patient with aortic aneurysm and dilations experienced improvement with immunosuppressive therapy for suspected aseptic abscess syndrome. Despite long-term treatment, further surgeries were needed, but no new aneurysms formed post-immunotherapy.
Area of Science:
- Vascular Surgery
- Immunology
- Radiology
Background:
- A 36-year-old male presented with a complex thoracoabdominal aortic aneurysm (TAA) and multiple dilations.
- Initial investigations for infection and inflammation were negative despite aneurysm tenderness.
Observation:
- Postoperative imaging revealed hypermetabolic intrasplenic collections.
- Aseptic abscess syndrome and aortitis were suspected based on imaging findings.
Findings:
- Immunosuppressive therapy led to dramatic clinical improvement.
- Despite initial success, the patient required multiple surgeries over 7 years for progressive aortic dilation, culminating in total aortic replacement.
- No new aneurysms developed after immunotherapy.
Implications:
- Aseptic abscess syndrome should be considered in complex aortic disease with negative infectious workups.
- Long-term immunosuppressive therapy may be necessary for managing certain inflammatory aortic conditions.
- Multidisciplinary management is crucial for patients with extensive aortic disease and associated inflammatory syndromes.
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