Inflammatory abdominal aortic aneurysms: a thirty-year review

Area of Science:

• Vascular Surgery
• Aortovascular Diseases
• Inflammatory Aneurysms

Background:

• Abdominal aortic aneurysm (AAA) repair is a common surgical procedure.
• Inflammatory AAA (IAAA) is a distinct subtype with unique clinical characteristics.
• Understanding IAAA is essential for improving patient outcomes.

Purpose of the Study:

• To review the clinical features, diagnostic methods, and outcomes of patients with inflammatory aortic or iliac aneurysms.
• To compare the characteristics and operative mortality of IAAA with atherosclerotic AAA.
• To identify key indicators for diagnosing IAAA preoperatively.

Main Methods:

• Retrospective review of operative records for 2816 patients undergoing AAA repair (1955-1985).
• Analysis of patient demographics, comorbidities, diagnostic findings, and surgical outcomes.
• Comparison of inflammatory AAA cases (n=127) with ordinary atherosclerotic aneurysms.

Main Results:

• Inflammatory aneurysms were identified in 4.5% of patients, predominantly men and heavy smokers.
• Patients with IAAA showed higher rates of elevated erythrocyte sedimentation rate (ESR), weight loss, and symptoms compared to atherosclerotic AAA.
• IAAA was associated with significantly increased operative mortality (7.9% vs. 2.4%).
• Diagnostic imaging like CT and excretory urography showed moderate sensitivity; angiography was unhelpful.
• The triad of abdominal pain, weight loss, and elevated ESR strongly suggests IAAA.

Conclusions:

• Inflammatory AAA is associated with a higher operative mortality and distinct clinical features.
• The combination of chronic abdominal pain, weight loss, and elevated ESR is highly suggestive of IAAA.
• Preoperative identification of IAAA is critical for optimizing patient preparation and surgical planning.