Ishikawa Nozomu, Yamamoto Naoto, Unno Naoki, Sano Masaki, Takeuchi Hiroya
Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, JPN.
Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN.
Cureus. 2025 Apr 25;17(4):e82964. doi: 10.7759/cureus.82964. eCollection 2025 Apr.
Inflammatory aneurysms (IAs) are characterized by the thickening of the arterial wall and fibrosis of periarterial tissues. Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is related to IAs, and about half of IA cases are considered IgG4-related. Although some cases of inflammation after endovascular aneurysm repair (EVAR) have been reported, its relationship with the serum levels of IgG4 has rarely been discussed. Here, we report on a patient diagnosed with and treated for an IA with elevated serum levels of IgG4 following EVAR. An 83-year-old man presented with a bilateral common iliac artery aneurysm. We observed no inflammatory features in his vital signs, laboratory test results, or computed tomography (CT) images. The patient was diagnosed with a non-inflammatory bilateral common iliac artery aneurysm. EVAR was performed using an infrarenal bifurcated stent graft (diameter, 31 mm; length, 15 cm; GORE EXCLUDER AAA Endoprosthesis (WL Gore & Associates, Inc., Flagstaff, AZ, USA)), with an ipsilateral limb stent graft (diameter, 12 mm; length, 7 cm; GORE EXCLUDER) deployed in the left external iliac artery and a contralateral limb stent graft (diameter, 12 mm; length, 14 cm; GORE EXCLUDER) deployed in the right external iliac artery. The patient was discharged in good condition. However, signs of inflammation were observed approximately one month after EVAR. CT images demonstrated the periarterial thickening of the common iliac arteries, and 18F-fluorodeoxyglucose positron emission tomography-CT revealed increased metabolic activity overlying the thickened periarterial tissue. The serum levels of IgG4 and soluble interleukin-2 receptor (sIL-2R) were elevated. The patient underwent steroid therapy based on the suspicion of IgG4-related IA of the common iliac arteries, resulting in reductions of inflammatory signs and periarterial thickening. However, when steroids were reduced, hydronephrosis, periarterial thickening, and increased serum IgG4 and sIL-2R levels were observed. The patient was diagnosed with a relapsed IA and treated with an increased steroid dosage. IAs may occur following EVAR. Steroid therapy may be an effective treatment for post-EVAR IAs, similar to common IAs. Long-term follow-up is desirable to monitor patients for the recurrence of inflammation during the treatment of post-EVAR IAs.
炎性动脉瘤（IAs）的特征是动脉壁增厚和动脉周围组织纤维化。免疫球蛋白G4（IgG4）相关疾病（IgG4-RD）与炎性动脉瘤相关，约半数炎性动脉瘤病例被认为与IgG4相关。尽管已有一些血管内动脉瘤修复术（EVAR）后发生炎症的病例报道，但很少有人讨论其与血清IgG4水平的关系。在此，我们报告1例接受EVAR后血清IgG4水平升高的炎性动脉瘤患者的诊断和治疗情况。1名83岁男性因双侧髂总动脉瘤就诊。其生命体征、实验室检查结果及计算机断层扫描（CT）图像均未显示炎症特征。该患者被诊断为非炎性双侧髂总动脉瘤。采用肾下分叉型覆膜支架（直径31 mm，长度15 cm；GORE EXCLUDER AAA腔内修复装置，美国亚利桑那州弗拉格斯塔夫市WL Gore & Associates公司）行EVAR，在左髂外动脉置入同侧肢体覆膜支架（直径12 mm，长度7 cm；GORE EXCLUDER），在右髂外动脉置入对侧肢体覆膜支架（直径12 mm，长度14 cm；GORE EXCLUDER）。患者出院时情况良好。然而，EVAR术后约1个月出现炎症迹象。CT图像显示双侧髂总动脉周围增厚，18F-氟脱氧葡萄糖正电子发射断层扫描-CT显示增厚的动脉周围组织代谢活性增加。血清IgG4和可溶性白细胞介素-2受体（sIL-2R）水平升高。基于怀疑双侧髂总动脉IgG4相关炎性动脉瘤，患者接受了类固醇治疗，炎症体征和动脉周围增厚减轻。然而，当类固醇减量时，出现了肾积水、动脉周围增厚以及血清IgG4和sIL-2R水平升高。该患者被诊断为复发性炎性动脉瘤，并接受了增加类固醇剂量的治疗。炎性动脉瘤可能在EVAR后发生。与普通炎性动脉瘤类似，类固醇治疗可能是EVAR后炎性动脉瘤的有效治疗方法。对EVAR后炎性动脉瘤患者进行治疗时，需要长期随访以监测炎症复发情况。
