Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms

Background: The operative management of inflammatory abdominal aortic aneurysms has evolved based on a concept of minimal dis section and the morbidity associated with open repair of inflammatory aneurysms has decreased. Despite such progress, the technical challenges associated with open repair of inflammatory aneurysms are formidable, and an endovascular approach is an appealing alternative that extends the con cept of minimal dissection. Objective: The objective of this report is to pro vide a literature-based statement on the endovascular repair of inflammatory abdominal aortic aneurysms concentrating on four main areas: feasibility of placement, efficacy of treatment, associated morbidity and mortality, and the response of perianeurysmal fibrosis and inflammation. Results: The pub lished experience with endovascular repair of inflammatory abdominal aor tic aneurysms is limited to two series of patients and fewer than 10 case reports. From this it appears that the endovascular repair of inflammatory abdominal aortic aneurysms is feasible and proceeds in a manner similar to the endovascular repair of degenerative aneurysms. Two aspects of endovas cular repair influenced by the unique presentation of inflammatory aneurysms are the measurement of attachment site diameters and the flexibil ity of iliac arteries. Endovascular repair of inflammatory aneurysms is effec tive in preventing rupture and reducing perioperative morbidity. The response of perianeurysmal fibrosis to endovascular repair is varied and does not appear to be related to endograft type or endoleak status. Conclusions: Preliminary experience with endovascular repair of inflammatory abdominal aortic aneurysms suggests that this technique is feasible, safe, and effective. The varied response of perianeurysmal inflammation to endovascular repair is not dissimilar to clinical experience with open inflammatory aneurysm repair and is influenced by yet undefined factors. BACKGROUND The triad of thickened aneurysm wall, perianeurysmal fibrosis, and dense adhesions of adjacent a.