Ureteral Entrapment Research Articles

Inflammatory Abdominal Aortic Aneurysms: A Report of Thirty-Seven Cases

Of a total of 780 patients with abdominal aortic aneurysms, 37 patients (4.7%) had inflammatory aneurysms. Presenting symptoms included back and abdominal pain (76%), leg edema, melena, uremia, claudication and pancreatitis. Mean erythrocyte sedimentation rate was 45 mm/hr. Weight loss and anorexia were common. Elevated urea and creatinine were seen on 11 patients, nine of whom had obstructive uropathy. Average aneurysm size was 9.3 cm. Thirty-six patients were treated surgically and one was observed. Involvement of the suprarenal (nine cases) or thoracic (three cases) aorta was common. Elective operations included resection and grafting in 21 patients and axillofemoral bypass in four patients. Patients with ureteral entrapment underwent simultaneous ureterolysis. Among the elective operations four deaths were noted (15%). Ten emergency operations were done for posterior rupture (four cases), aortoduodenal fistula (one case), inferior vena cava obstruction or fistula (two cases), hemorrhage into the aneurysmal wall (two cases), or presumed rupture (one case). There were seven deaths (70%) in this group. The operation of choice for inflammatory aneurysm is a bifurcation graft combined with ureterolysis.

Clinical Case Reports

As more cases of perianeurysmal retroperitoneal fibrosis causing ureteral entrapment are reported in the urological literature, it becomes evident that preoperative evaluation of the urological tract is extremely cogent not only to evaluate renal function, anatomy and distortion but also to decide whether ureterolysis need be added to the vascular surgical procedure. Recently Friedel, Smith and Herman added a tenth case of perianeurysmal fibrosis to the world urological literature. Nearly simultaneously we were treating a patient with an abdominal aneurysm and mid-ureteral entrapment and would therefore like to add our case from the vascular surgeon's viewpoint.