Inflammatory Aortic Aneurysm Research Articles

Inflammatory Aortic Aneurysms: A Clinical Review with New Perspectives in Pathogenesis

Inflammatory Aortic Aneurysms: A Clinical Review with New Perspectives in Pathogenesis

さ声で初発した血管型ベーチェット病例

In this paper, a very rare case of vasculo (angio)-Behcet's disease initiated with hoarseness due to inflammatory aortic aneurysm, is presented. A 35 year-old male with persistent hoarseness for half a month was revealed to have left recurrent laryngeal nerve palsy. Chest X-ray films showed slight enlargement of the aortic arch. CT demonstrated direct evidence of a saccular type aortic aneurysm at the branched area of the left subclavian artery. Aortic angiography demonstrated two additional aortic aneurysms at the right subclavian artery and in the lower abdominal area. The patient subsequently underwent emergency surgery for treatment of these aneurysms. The histopathological characteristics of the representative aortic aneurysmal lesions suggested a diagnosis of “vasculo-Behcet's disease”. Behcet's disease is usually characterized by oral and genital ulceration, folliculitis and uveitis. This patient, however, displayed no previous evidence of these symptoms. We would like to emphasize that some cases of left recurrent laryngeal nerve palsy require urgent management.

Inflammatory Aneurysm of the Ascending Aorta and Aortic Arch

Inflammatory aortic aneurysms are distinct clinical entities seen mostly in the infrarenal abdominal aorta and rarely in the descending thoracic aorta. We present the case of a 61-year-old woman with an inflammatory aortic aneurysm of the ascending aorta and aortic arch.

Inflammatory aortic aneurysms: Regression of fibrosis after aneurysm surgery

To evaluate the fate of perianeurysmal fibrosis (PF) following aneurysm surgery. In this single centre study, pre- and postoperative abdominal CT-scans on 21 consecutive patients with inflammatory abdominal aortic aneurysms were compared. CT-scans of 10 randomly chosen patients operated on for abdominal aortic aneurysms without PF in the same period, served as reference group. Preoperative thickness of PF was assessed as > 1 cm in 11 and < 1 cm in 10 patients. Ureterolysis was performed in seven patients where the fibrosis caused ureteral obstruction. Postoperative CT-scans performed at a median of 24 (range 3-108) months after surgery showed complete regression of the fibrosis in 29%, partial regression in 57% and no change in 14% of the patients. Progression of the fibrosis or persistence of hydronephrosis was not seen. No sign of fibrosis were seen in the 10 controls. This study supports the findings that PF tends to regress after repair of the abdominal aortic aneurysm.

Endovascular repair of an inflammatory aortic aneurysm

Endovascular repair of an inflammatory aortic aneurysm

Nonaneurysmal Aortoarteritis

Aortoarteritis is an uncommon form of retroperitoneal inflammation, which is not associated with an aortic aneurysm or luminal stenosis. The authors report 3 patients with periaortic inflammation whose presentations were initially suggestive of a symptomatic aortic aneurysm. All 3 patients had pain, an epigastric mass, and weight loss. The correct diagnosis was suggested by imaging techniques and confirmed by computerized (CT) -directed needle biopsy in 2 of the patients. Aortic caliber was not altered significantly in any patient. They were all treated with corticosteroids with prompt relief of symptoms and rapid resolution of the periaortic inflammation as confirmed by CT. There has been no recurrence of symptoms in follow-up. Aortoarteritis appears to be one expression of the spectrum of inflammatory retroperitoneal diseases and is distinct from inflammatory aortic aneurysms and retroperitoneal fibrosis. The authors suggest a logical classification scheme of retroperitoneal inflammation based on the extent of aortic and retroperitoneal involvement. Differentiation between these entities is critical because, in contrast to inflammatory aneurysms and retroperitoneal fibrosis involving the aorta, aortoarteritis can be managed without surgery. Magnetic resonance imaging displays the most detail of the periaortic mass and provides information about intra-aortic flow. Corticosteroids are rapidly effective and are the treatment of choice in aortoarteritis when the diagnosis is established.

Retroperitoneal Approach for Repair of Inflammatory Aortic Aneurysms

Inflammatory aortic aneurysms (IAAs) are characterized by a markedly thickened aortic wall and dense perianeurysmal fibrosis. The presence of such inflammation and subsequent organ adherence makes surgical repair of IAAs more challenging than repair of simple atherosclerotic aneurysms. From March 1987 to June 1994, twelve patients underwent surgical repair of an IAA by a single surgeon. Ten patients were men (83%) and the mean age was 68.3 years (range 58 to 93 years). All patients except one were symptomatic with back or abdominal pain, yet none had evidence of aneurysm rupture at operation. Preoperatively 90% (9/10) of the patients had an elevated erythrocyte sedimentation rate (ESR), 100% (12/12) had a predictive CT scan, and all patients with aortic wall pathology specimens had their diagnosis confirmed. Six patients had a left flank retroperitoneal surgical approach, five had a transabdominal approach, and one had ligation and extra-anatomic reconstruction. The choice of repair technique was based on the degree and anatomic distribution of perianeurysmal fibrosis. The 30-day operative mortality rate was 0%. Mean follow-up was 56.3 months. Aortoduodenal fistula occurred in one patient 5 months after transperitoneal repair. Technical difficulties encountered during subsequent transperitoneal repairs led to the evolution of a policy in which the retroperitoneal approach was preferred in all patients with CT evidence of IAA. It is concluded that IAA represents a spectrum of retroperitoneal fibrosis and inflammation that is best treated surgically via a retroperitoneal approach.

Detection of active cytomegalovirus infection in inflammatory aortic aneurysms with RNA polymerase chain reaction

Purpose: We previously reported the possible role of human cytomegalovirus in the pathogenesis of inflammatory aortic diseases. To further analyze the viral cause of human aortic diseases, in this study we examined the presence and the replication of human Herpesviridae in 60 aortic tissues, including 7 inflammatory aneurysms, 37 atherosclerotic aneurysms, and 16 normal aortas.Methods: To detect the genome of herpes simplex virus (type 1, type 2), cytomegalovirus, and Epstein-Barr virus, DNA polymerase chain reaction for each virus was performed. To analyze these herpesviral replications, the viral transcript was detected with RNA polymerase chain reaction.Results: The DNA polymerase chain reaction showed that either herpes simplex virus or cytomegalovirus was present more frequently in inflammatory (29% or 86%, respectively) and atherosclerotic aneurysms (27% or 65%, respectively) than in normal aortic tissues (6% or 31%, respectively), whereas the Epstein-Barr viral genome was not detected in any aortic tissue specimens. By the use of RNA polymerase chain reaction, only the cytomegaloviral transcript was recognized in 71% of the inflammatory aneurysms but was not recognized in any other tissue specimens. No other herpesviral transcripts were detected in any tissue specimens examined in this study.Conclusions: Our results thus suggest that the human herpesviruses may play various roles in the pathogenicity of aortic diseases, in particular the replicating infections of the cytomegalovirus might potentially cause the formation of inflammatory aneurysms.

The Diagnosis and Management of Arteritis

Inflammatory arterial disease is often insidious and associated with a substantial morbidity and mortality. Early recognition is vital. Patients with arteritis (n = 106) were studied and divided into five groups. Two of these were subgroups of giant cell arteritis classified by site into either cranial arteritis (66), or upper limb arteritis (7). Three other groups were identified; chronic periaortitis (with or without inflammatory aortic aneurysm) (7), polyarteritis nodosa (14), and small vessel arteritis (12). Clinicians are not sufficiently aware of arteritis and its many atypical presentations. Delay in management is associated with a significant morbidity and mortality. In this district serving 200,000 people at least one patient per month is seriously at risk from the disease. Improved outlook depends on early recognition of the clinical syndromes and rapid appropriate treatment.

Inflammatory aortic aneurysms: Characteristic appearance on magnetic resonance imaging

Ten to 15% of all aortic aneurysms show inflammatory change. They are characteristically covered on their anterior and lateral sides with thick white fibrous tissue. Peri-aortic fibrosis may spread into the retroperitoneum to encase and obstruct adjacent organs making operative treatment more difficult and increasing the operative morbidity and mortality. Fifteen patients with inflammatory aneurysms and 46 patients with simple non-inflammatory aneurysms were studied prospectively. Each patient underwent magnetic resonance imaging (MRI) using a Picker Vista MR2055 scanner operating at 0.5 tesla. Each scan was reviewed by a radiologist (G.G.H.) preoperatively and a diagnosis of inflammatory or non-inflammatory aneurysm made. At operation, the diagnosis of aneurysm type was made on macroscopic features of inflammatory change, and confirmed histologically using previously published criteria. The radiological diagnosis was found to correspond to the surgical and pathological diagnosis in all cases. In cases of inflammatory aortic aneurysm the aneurysm wall appeared laminated on MRI scan, showing three or more bright, high-signal layers. These appearances of inflammatory change are characteristic, and were present in all 15 patients with such aneurysms. There were no false positives among those patients with simple aneurysms, and no false negatives. Operative specimens of aortic wall were taken from four patients with inflammatory aortic aneurysms and four patients with simple non-inflammatory aortic aneurysms, and subjected to MRI scanning. The characteristic banding appeared only in the inflammatory aneurysm wall samples. Magnetic resonance imaging is a highly sensitive investigative technique for the detection of inflammatory aneurysms, showing characteristic changes. These changes are also seen in in vitro scans of wall samples from inflammatory aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic activity in inflammatory and non-inflammatory aneurysms of the abdominal aorta

Inflammatory aneurysms of the abdominal aorta (IAA) comprise 10-15% of all aortic aneurysms (AA) but their aetiology and pathogenesis are obscure. Destruction of mural elastin is a prominent feature of IAA, and both increased elastolysis and decreased inhibition of elastolysis have been implicated. In order to study these factors, we have examined the peripheral blood of three groups of patients; 15 with inflammatory aortic aneurysms (IAA), 61 with simple aortic aneurysms (SAA) and 35 with aorto-iliac occlusive disease (OD). In all cases, alpha-1-anti-trypsin (A-1-AT), alpha-2-macroglobulin (A-2-MG), elastase inhibitory activity (E.I.A.), elastase-anti-trypsin complex, C-reactive protein (CRP), caeruloplasmin (CP) and plasma viscosity were measured. Patients with IAA had a significantly higher plasma viscosity (Mann-Whitney, p less than 0.05), E.I.A. (Mann-Whitney, p less than 0.01) and levels of A-1-AT, CRP, CP and elastase/anti-trypsin complex (Mann-Whitney, all p less than 0.05) than patients in the other two groups. There was no difference in the levels of A-2-MG between any of the groups. This study refutes the theory that reduced inhibition of elastase activity predisposes to the formation of SAA. In patients with IAA, raised marker levels indicate ongoing destruction of elastin, and suggest a difference in pathogenesis between IAA and SAA. The study also suggests that IAA are highly active metabolically, as opposed to the more degenerative SAA.

Magnetic resonance imaging — Applications to the staging of inflammatory and simple aortic aneurysms

Magnetic resonance imaging — Applications to the staging of inflammatory and simple aortic aneurysms

Inflammatory abdominal aortic aneurysms: A disease entity?

Sixty inflammatory aortic aneurysms of unknown aetiology were examined by serial sections. The histological findings failed to reveal significant differences in either thoracic or abdominal aneurysms with or without marked adventitial fibrosis. Their identical morphology does not favour the existence of a special disease entity of so-called inflammatory abdominal aortic aneurysms (IAAA). Absence or existence of giant cells of any type, occurrence of plasma cells, eosinophils, granulomas, fibrinoid necrosis and adventitial fibrotic thickening cannot be considered as variables which help in differentiation. IAAA are characterized by a marked predominance of male patients and a rather benign clinical course. They usually affect the age group around 60 years. They are not rare and do not seem to be restricted to certain races. Their aetiology, like that of the cases affecting the thoracic aorta (Takayasu's disease, non-specific aortitis) remains unknown, although autoimmune diseases, the retroperitoneal fibrosis of Ormond and arteriosclerosis may be related. However, on the basis of the present evidence we cannot consider them to be one of these diseases. There are no morphological findings which would justify the separation of IAAA from Takaysu's disease.

Portal hypertension and chronic pancreatitis complicating an inflammatory aortic aneurysm

A case of inflammatory abdominal aortic aneurysm (AAA) is described in which the inflammatory process extended to the porta hepatis leading to portal hypertension, and to the root of the small bowel mesentery with associated chronic pancreatitis. We have been unable to find a similar case recorded in the literature.

The assessment of inflammatory aortic aneurysms with computed tomography.

SUMMARYInflammatory aneurysms are a rare and distinct form of abdominal aortic aneurysm that produce abdominal pain and a periaortic soft tissue mass. CT has a limited but useful role in the diagnosis and follow up of this condition.ABSTRACTThe CT scans of 8 patients with operatively diagnosed inflammatory aneurysms are presented. The scans were independently read by 4 radiologists in an attempt to assess the CT criteria and determine the correlation between surgical and CT diagnosis of this entry.In only 4 of the cases was inflammatory aneurysms thought the most likely diagnosis, it was a possible diagnosis in a further 2 cases. This result is most likely due to the marked similarity between this and other causes of periaortic soft tissue masses.In this study CT appears to have a definite but limited place in assessing inflammatory aortic aneurysms. It allows assessment of non specific abdominal pain in the presence of an aneurysm, aids in the diagnosis of periaortic masses and may warn the surgeon of the presence of inflammatory aneurysm. The initial management of a patient with an abdominal aortic aneurysm and abdominal pain however should remain surgical.

Inflammatory aneurysm of aorta: Development documented by computed tomography

Aortic aneurysmal disease appears to be the central focus of the inflammatory process resulting in inflammatory aneurysm formation. Some authors believe that inflammatory aortic aneurysm disease is a distinct clinicopathologic entity; however, others have included it with retroperitoneal fibrosis. The histologic features of inflammatory aneurysm suggest an immunologic basis for the lesion, with the atherosclerotic aorta as a possible source of the allergen.

EMERGENT OPERATION FOR TRUE AORTIC ANEURYSM

Between January 1981 and December 1986, forty patients with true aortic aneurysm were treated at Iwakuni National Hospital. Twelve patients with ruptured aortic aneurysms and six patients with aortic aneurysms threatening rupture underwent emergent operations. Two patients had thoracoabdominal aortic aneurysm and sixteen had abdominal aortic aneurysm. Fourteen patients were arteriosclerotic and four were inflammatory. Preoperative conditions, operative procedures and results were studied. For the diagnosis of ruptured aortic aneurysm, emergent CT scan was most important and sufficient. The average time from admission to operation was two hours. It was concluded that primary care was important to shorten this time. Operative procedures were selected mainly with regard to saving life. In the postoperative management, adequate renal plasma flow was maintained. The results of operative mortality indicate that patients with inflammatory aortic aneurysm should be treated by immediate elective operation.

Inflammatory abdominal aortic aneurysms: A thirty-year review

The operative records of 2816 patients undergoing repair for abdominal aortic aneurysm (AAA) from 1955 to 1985 were reviewed. Inflammatory aortic or iliac aneurysms were present in 127 patients (4.5%), 123 men and four women. Most patients were heavy smokers (92.1%). Clinical evidence of peripheral arterial occlusive disease and coronary artery disease was found in 26.6% and 39.4%, respectively. Additional aneurysms occurred in half of the patients; iliac aneurysms were the most common (55 patients), followed by thoracic or thoracoabdominal (17 patients), femoral (16 patients), and popliteal aneurysms (10 patients). Ultrasound and computed tomography suggested the diagnosis in 13.5% and 50%, respectively; angiography was not helpful. Excretory urographic findings of medial ureteral displacement or obstruction suggested the diagnosis in 31.4%. The aneurysm was repaired in 126 patients. Only one patient experienced acute aneurysm rupture, but eight patients had chronic contained leakage. When compared with patients who have ordinary atherosclerotic aneurysms, patients with inflammatory aneurysms are significantly more likely to have (1) an elevated erythrocyte sedimentation rate (ESR, 73% vs. 33%, p < 0.0001); (2) weight loss (20.5% vs. 10%, p < 0.05); (3) symptoms (66% vs. 20%, p < 0.0001); and (4) an increased operative mortality rate (7.9% vs. 2.4%, p < 0.002). The triad of chronic abdominal pain, weight loss, and elevated ESR in a patient with an abdominal aortic aneurysm is highly suggestive of an inflammatory aneurysm and may be beneficial in the preoperative preparation of the patient for aneurysm repair.

Infected aortic aneurysms

Salmonella organisms have been responsible for half of the reported cases of infected aortic aneurysms, although other bacteria have been incriminated. This is the second reported case in which Campylobacter fetus subspecies fetus apparently infected an inflammatory aortic aneurysm. In this 70-year-old man the organism was isolated and treated prior to resection of the aneurysm and inline grafting. Specific antibiotic therapy was continued for 8 weeks postoperatively. Examination and CT scans obtained after 9 months of follow-up reveal no evidence of recurrent infection.