Retroperitoneal Fibrosis Secondary to the Placement of Aorto-iliac Stents

Abstract

Introduction: Retroperitoneal fibrosis (RF) is a rare disorder characterized by inflammation and fibrosis in the periphery of the abdominal aorta (1). In about two thirds of the cases this condition is idiopathic (2). It is known that inflammatory aneurysms could be associated with RF and regression of periaortic inflammation after endovascular treatment (EVAR) of the aneurysm was described (3). However, very little is known about the possibility of this condition being associated with the implantation of endovascular devices. In the literature there is only one report of a clinical case in which the RF was secondary to the implantation of a kissing stent of the common iliac arteries (4). Periaortitis and periaortic fibro-inflammatory alterations secondary to stent graft implantation in the correction of abdominal aortic aneurysms have also been demonstrated, with 5 cases described in the literature (5,6,7,8,9). In some of these cases, patients presented complications of RF, such urethral obstruction with hydronephrosis. Possibly, since the symptoms of the disease are non-specific, the condition tends to be underreported and underdiagnosed. The pathophysiology of this pathological process is not known; however, it was proposed that the angioplasty and stenting can disturb plaque integrity with antigen exposure, triggering a local inflammatory response (10). Methods: We describe two cases of retroperitoneal fibrosis secondary to endovascular intervention of arterial aortic iliac axes with angioplasty and stent/stent-graft placement. Results: We present our experience with two patients with Leriche Fontaine IIb arteriopathy, one with pre-occlusive stenosis of the left common iliac artery treated with percutaneous transluminal angioplasty (PTA) and stenting, other with morphologically significant stenosis of the infrarenal abdominal aorta where PTA and kissing stent with two aortoiliac stent-grafts was performed. Following the endovascular procedure, both patients had manifested marked lumbar pain and elevation of serum inflammatory markers. A periaortic inflammatory process suggestive of retroperitoneal fibrosis was visualized on computed tomography angiography (CTA). In both patients the clinical condition was reverted with steroid therapy without recurrence of symptoms. Conclusion: These cases demonstrate the possible relationship between the implantation of aortoiliac stents and the development of retroperitoneal fibrosis. The published literature is very scarce. This complication, like all forms of chronic periaortitis, responds well to corticotherapy with symptom resolution. Disclosure: Nothing to disclose