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Inflammatory abdominal aortic aneurysms: a case-control study
S S Nitecki1, J W Hallett, A W Stanson
1Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA.
Purpose:
This study was designed to identify significant differences in the clinical and radiologic characteristics and outcome between patients with inflammatory and noninflammatory abdominal aortic aneurysms (AAAs).
Methods:
We reviewed 29 consecutive patients who underwent repair of an inflammatory AAA between 1985 and 1994. This group was matched in a case-control fashion by date of surgery and by the performing surgeon to a group of 58 patients who underwent repair of noninflammatory AAAs.
Results:
The two groups had comparable characteristics of age, gender, and cardiovascular risk factors. Patients with inflammatory AAAs were significantly more symptomatic than those with noninflammatory AAAs (93% vs 9%, p < 0.001), were more likely to have a family history of aneurysms (17% vs 1.5%, p = 0.007), and tended to be current smokers (45% vs 24%, p = 0.049). The most significant laboratory difference was an elevated sedimentation rate in patients with inflammatory AAAs (mean, 53 mm/hr vs 12 mm/hr, p < 0.00001). Inflammatory AAAs also were significantly larger than noninflammatory AAAs at presentation (6.8 cm vs 5.9 cm, p < 0.05). Although operative mortality was low in both groups, patients with an inflammatory AAA tended to have higher morbidity, including sepsis (p < 0.01) and renal failure (p = 0.04). Five-year survival rates, however, were similar for the two groups (79% for inflammatory and 83% for noninflammatory AAAs). On follow-up computed tomographic scans, the retroperitoneal inflammatory process resolved completely in 53% of the patients, but 47% of patients had persistent inflammation that involved the ureters in 32% and resulted in long-term solitary or bilateral renal atrophy in 47%.
Conclusions:
This case-control study provides preliminary evidence that inflammatory AAAs may have a relatively strong familial connection and that current smoking may play an important role in the inflammatory response. The study also documents that persistent retroperitoneal inflammation may be more prevalent than has been previously reported, and stresses the need for an improved understanding of the pathogenesis and long-term management of inflammatory AAAs.
Insights
Inflammatory abdominal aortic aneurysms (AAAs) present with more symptoms and are larger than noninflammatory AAAs. Persistent inflammation can lead to complications, highlighting the need for better understanding and management.
Area of Science:
- Vascular Surgery
- Inflammatory Diseases
- Aneurysm Research
Background:
- Abdominal aortic aneurysms (AAAs) can be inflammatory or noninflammatory.
- Understanding differences is crucial for patient management.
Purpose of the Study:
- To identify clinical, radiologic, and outcome differences between inflammatory and noninflammatory AAAs.
- To compare patient characteristics and long-term outcomes.
Main Methods:
- A case-control study comparing 29 patients with inflammatory AAAs to 58 with noninflammatory AAAs.
- Matching was performed by date of surgery and surgeon.
- Data included clinical presentation, laboratory results, and imaging follow-up.
Main Results:
- Inflammatory AAAs were more symptomatic (93% vs 9%), larger (6.8cm vs 5.9cm), and associated with higher smoking rates and family history.
- Elevated sedimentation rates were noted in inflammatory AAAs.
- Higher morbidity (sepsis, renal failure) occurred in inflammatory AAA patients, though 5-year survival was similar.
Conclusions:
- Inflammatory AAAs may have a genetic link and be influenced by smoking.
- Persistent retroperitoneal inflammation is common, affecting ureters and causing renal atrophy.
- Further research into pathogenesis and long-term management of inflammatory AAAs is needed.