RETROPERITONEAL APPROACH FOR REPAIR OF INFLAMMATORY AORTIC-ANEURYSMS

Inflammatory aortic aneurysms (IAAs) are characterized by a markedly t hickened aortic wall and dense perianeurysmal fibrosis. The presence o f such inflammation and subsequent organ adherence makes surgical repa ir of IAAs more challenging than repair of simple atherosclerotic aneu rysms. From March 1987 to June 1994, twelve patients underwent surgica l repair of an IAA by a single surgeon. Ten patients were men (83%) an d the mean age was 68.3 years (range 58 to 93 years). All patients exc ept one were symptomatic with back or abdominal pain, yet none had evi dence of aneurysm rupture at operation. Preoperatively 90% (9/10) of t he patients had an elevated erythrocyte sedimentation rate (ESR), 100% (12/12) had a predictive CT scan, and all patients with aortic wall p athology specimens had their diagnosis confirmed. Six patients had a l eft Rank retroperitoneal surgical approach, five had a transabdominal approach, and one had ligation and extra-anatomic reconstruction. The choice of repair technique was based on the degree and anatomic distri bution of perianeurysmal fibrosis. The 30-day operative mortality rate was 0%. Mean follow-up was 56.3 months. Aortoduodenal fistula occurre d in one patient 5 months after transperitoneal repair. Technical diff iculties encountered during subsequent transperitoneal repairs led to the evolution of a policy in which the retroperitoneal approach was pr eferred in all patients with CT evidence of IAA. It is concluded that IAA represents a spectrum of retroperitoneal fibrosis and inflammation that is best treated surgically via a retroperitoneal approach.