De-novo peri-aortic inflammation after endovascular abdominal aneurysm repair

BACKGROUND: De-novo peri-aortic inflammation (DPAI) is a rare and unclear complication after endovascular aneurysm repair (EVAR), that has been reported only in few cases. The aim of the present study is to report our center’s experience and review the literature results. METHODS: Patients undergone elective EVAR from 2005 to 2013 for infra-renal abdominal aortic aneurysm (AAA) were prospectively collected in a dedicated database and retrospectively evaluated. All cases developing DPAI after EVAR were extrapolated and analyzed. DPAI was defined by computed tomography angiography (CTA) as the onset of aortic wall thickening >0.5 cm detected during EVAR follow-up. Primary inflammatory AAAs (iAAA) were not included in the study. Aims were to evaluate the incidence and the natural history of DPAI after EVAR, with its possible treatment. A systematic literature review of related articles was carried out through PubMed. RESULTS: Between 2005 and 2013, 713 patients underwent electively EVAR for AAA. Among these, three cases (0.4%) of DPAI were detected during the follow-up. All cases had related symptoms such as abdominal/back pain, fever and fatigue. Two patients were successfully treated with oral steroid therapy (prednisone 30 mg daily) for 6 months; one was converted to open repair because the DPAI was associated with a persistent type II endoleak and significant AAA sac enlargement. Between 2002 and 2014, five case reports (six patients) of DPAI after EVAR have been published, with no clinical series reported. In two cases, DPAI completely regress with oral steroid therapy, in three cases medical therapy (prednisone and/or tamoxifen) was associated with ureteric stenting for the presence of related hydronephrosis and in one case a nephrectomy was necessary. CONCLUSIONS: The DPAI after EVAR is a rarely detected complication, with possible serious consequences. An early recognition and medical treatment through oral steroid and/or tamoxifen is important to stop the inflammation and prevent ureteric and renal impairment. Ureteric stenting should be performed in case of urinary obstruction.