Caradu Caroline, Ammollo Raffaele P, Dari Loubna, Wanhainen Anders, Van Herzeele Isabelle, Bellmunt-Montoya Sergi, Ducasse Eric, Bérard Xavier
Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France.
Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France; Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy.
Eur J Vasc Endovasc Surg. 2023 Apr;65(4):493-502. doi: 10.1016/j.ejvs.2023.01.003. Epub 2023 Jan 7.
Inflammatory abdominal aortic aneurysms (InflAAAs) account for 5 - 10% of aortic aneurysms and are characterised by retroperitoneal fibrosis. Diagnosis is often delayed, and doubts remain about the optimal management strategy. This scoping review describes the current state of knowledge on InflAAAs.
Medline, PubMed, EMBASE, and Scopus were searched for relevant studies that evaluated the diagnosis and treatment of InflAAAs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was followed.
Fifty-seven papers were selected (low level of evidence), which included 1 554 patients, who were mostly male and heavy smokers. A triad of chronic abdominal or back pain, weight loss, and elevated inflammatory markers was highly suggestive of the diagnosis but rarely present, and fever was noted only randomly. A mantle sign was seen on computed tomography angiography (CTA) in 73 - 100% of patients. Open surgical repair (OSR) and endovascular aortic aneurysm repair (EVAR) was reported in 1 376 and 178 patients, respectively. OSR was associated with significant iatrogenic bowel (n = 22), urinary tract system (n = 7), venous (n = 30), pancreatic (n = 6), and splenic (n = 5) injuries, while EVAR was associated with lower 30 day mortality (0 - 5% vs. 0 - 32%). One and two year mortality rates were similar between the two treatment modalities (0 - 20% and 0 - 36%, respectively). EVAR was more often associated with post-operative progression of inflammation (17% vs. 0.4%), and a higher frequency of persistent hydronephrosis (> 50%) and limb occlusion (20%). Used in < 10% of patients, corticosteroids led to complete pain relief and a reduction in peri-aortic inflammation within 6 - 18 months.
InflAAAs are characterised by non-specific symptoms, with the mantle sign on CTA being pathognomonic. Corticosteroids may be considered a basic treatment that all patients should receive initially. Low quality data indicate that EVAR (vs. OSR) is associated with fewer intra-operative complications and lower peri-operative mortality but more late fibrosis related adverse events. International multicentre registries are required to gather more insights into this challenging pathology.
炎性腹主动脉瘤（InflAAA）占腹主动脉瘤的5%-10%，其特征为腹膜后纤维化。诊断往往延迟，对于最佳治疗策略仍存在疑问。本范围综述描述了关于炎性腹主动脉瘤的当前知识状态。
检索Medline、PubMed、EMBASE和Scopus以查找评估炎性腹主动脉瘤诊断和治疗的相关研究。遵循系统评价和Meta分析的首选报告项目（PRISMA）方案。
选取了57篇论文（证据水平低），其中包括1554例患者，这些患者大多为男性且吸烟量大。慢性腹痛或背痛、体重减轻和炎症标志物升高的三联征强烈提示诊断，但很少出现，发热仅偶尔有记录。73%-100%的患者在计算机断层扫描血管造影（CTA）上可见“套征”。分别有1376例和178例患者接受了开放手术修复（OSR）和血管腔内腹主动脉瘤修复（EVAR）。OSR与显著的医源性肠损伤（n=22）、泌尿系统损伤（n=7）、静脉损伤（n=30）、胰腺损伤（n=6）和脾损伤（n=5）相关，而EVAR与30天较低死亡率相关（0%-5%对0%-32%）。两种治疗方式的1年和2年死亡率相似（分别为0%-20%和0%-36%）。EVAR更常与术后炎症进展相关（17%对0.4%），以及更高频率的持续性肾盂积水（>50%）和肢体闭塞（20%）。皮质类固醇在不到10%的患者中使用，可导致疼痛完全缓解，并在6-18个月内减轻主动脉周围炎症。
炎性腹主动脉瘤的特征为非特异性症状，CTA上的“套征”具有诊断特异性。皮质类固醇可被视为所有患者最初都应接受的基本治疗。低质量数据表明，EVAR（与OSR相比）与术中并发症较少和围手术期死亡率较低相关，但与更多晚期纤维化相关不良事件相关。需要国际多中心注册研究以更深入了解这种具有挑战性的病理情况。
