Inflammatory aneurysms of the abdominal aorta: New perspectives in pathogenesis and management

Purpose: To review the diagnosis, operative management, and long-term survival of patients with inflammatory abdominal aortic aneurysms (AAAs). In addition, to present emerging data on the etiology of inflammatory AAAs and present changing perspectives which offer new insight into the cause of inflammatory and noninflammatory aneurysms. Background: Inflammatory AAAs represent 5 to 10% of all AAAs. They chal lenge the vascular surgical team with unique problems in diagnosis, manage ment, and technique. Progress has occurred in the technical approach to these aneurysms, and operative morbidity has been reduced. However, the patho genesis remains enigmatic. Recent studies emphasize the influence of tobacco and implicate immune-response genes that appear to accentuate a destructive antigen-driven inflammatory process. Findings: Continued advances in the definition, diagnosis, management, and long-term survival of patients with inflammatory AAAs have been substantial in the past 15 years. In addition, an evolution in thought regarding the etiology of inflammatory AAAs has occurred. In contrast to initial descriptions of a distinct clinical entity, recent evidence suggests that inflammatory AAAs arise from the same etiologic stimulus responsible for the more common atherosclerotic AAA. Conclusions: The development of inflammatory AAAs is likely an antigen- driven response influenced by several genetic, endothelial, and environmental factors. With advances in diagnosis and technique, inflammatory AAAs can currently be managed with similar operative morbidity, mortality, and long- term survival to noninflammatory AAAs.