Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

Abstract

Endovascular aortic repair (EVAR) of inflammatory abdominal aortic aneurysms (IAAAs) avoids injury to organs adherent to the aneurysms during open surgery, but the long-term results and effects on urinary obstruction remain unclear. A 71-year-old man presented with IAAA, 44 mm in diameter, and a bilateral common iliac aneurysm, 42 mm in diameter. Both ureters exhibited perianeurysmal fibrosis, triggering hydronephrosis. Preoperative serum IgG4 level was high (147 mg/dL). Despite immediate reductions in aneurysm diameters and CRP level after EVAR, neither the perianeurysmal thickening nor hydronephrosis nor serum IgG4 level improved. We prescribed an oral steroid; the thickening gradually regressed. The aneurysm diameter fell immediately after EVAR, but the perianeurysmal thickening of the patient did not. A course of oral steroids was important in ensuring eventual perianeurysmal thickening regression.