Vijaynagar Badri, McMahon Greg S, McCarthy Mark J
Vascular Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.
Ann Vasc Surg. 2011 May;25(4):558.e5-7. doi: 10.1016/j.avsg.2010.10.015.
The periaortitis seen with inflammatory abdominal aortic aneurysms usually resolves after repair by both open and endovascular techniques. Conversely, the de novo development of retroperitoneal fibrosis after endovascular aneurysm repair (EVAR) has also been rarely described, and we present a case and also review the literature.
A 63-year-old man underwent EVAR for an asymptomatic, noninflammatory abdominal aortic aneurysm, presenting 9 months subsequently with left loin pain, raised inflammatory markers, and radiological evidence of periaortic inflammation causing significant left ureteric obstruction. Ureteric stenting resolved the hydronephrosis, and the periaortitis improved with combination of steroid and tamoxifen therapy.
Periaortitis causing renal impairment after EVAR is a rare complication. Prompt recognition and ureteric stenting helps to prevent long-term renal damage. Steroid and tamoxifen therapy is recommended to treat and avoid recurrence of periaortitis.
炎性腹主动脉瘤伴发的主动脉周炎通常在开放手术和血管腔内修复术后得到缓解。相反，血管腔内动脉瘤修复术（EVAR）后新发腹膜后纤维化的情况也鲜有报道，我们在此报告一例病例并复习相关文献。
一名63岁男性因无症状、非炎性腹主动脉瘤接受了EVAR，9个月后出现左腰疼痛、炎症指标升高，影像学显示主动脉周围炎症导致左侧输尿管严重梗阻。输尿管支架置入术缓解了肾积水，联合使用类固醇和他莫昔芬治疗后主动脉周炎有所改善。
EVAR后导致肾功能损害的主动脉周炎是一种罕见的并发症。及时识别并进行输尿管支架置入有助于预防长期肾损害。建议使用类固醇和他莫昔芬治疗并避免主动脉周炎复发。
