INFLAMMATORY ABDOMINAL AORTIC-ANEURYSMS - A RETROSPECTIVE STUDY OF 110 CASES

OBJECTIVE: The purpose of this study is to review our experience with the surgical treatment of 110 patients with an inflammatory abdominal aortic aneurysm (IAAA). Furthermore, we focus especially on 37 uretera l obstructions. PATIENTS AND METHODS : Between 1978 and 1996 we treate d 110 patients for an IAAA. It concerned 101 men and nine women with m ean age of 66.8 years. Emergency surgery was performed in 32 patients (13 ruptures) and elective surgery in 78 patients (only 23 asymptomati c). The IAAA diagnosis was made by CT scan preoperatively in 40 % of t he patients. Compression of 37 ureters in 23 patients (14 bilateral, 9 unilateral) was noticed and ureteral stenting was performed preoperat ively in nine patients (12 ureters). The surgical approach was median laparotomy (88 patients) or retroperitoneal approach (21 patients). On e patient was treated with an endovascular Min-Tee Stentor aortic graf t by femoral approach. Suprarenal clamping was necessary in 44 patient s. Ureterolysis of 23 ureters was performed. Three peroperative iatrog enic lesions were successfully treated intraoperatively. RESULTS: Fata l complications occurred in nine patients (8 %), five patients after u rgent surgery and four patients after elective surgery, all of them re lated to technical problems. Non fatal complications occurred in 22 pa tients, renal insufficiency was most important in ten patients (two pe rmanent dialysis). The mean follow-up was 4.5 years (range, 0.5 to 15 years). Late survival was 68 % at 5 years and 42 % after 10 years. Sev en patients presented late graft related complications, one fatal. In 14 surviving patients with 21 ureterolysed ureters, one needed a nefre ctomy and one a bilateral Boari-plasty. In eight surviving patients wi th II stented ureters, one patient needed a small bowel interposition for ureteral stricture. After CT evaluation, all ureteral stents were removed 3 to 6 months after surgery. CONCLUSIONS: 1. Surgery for IAAA is quite complex. Mortality and morbidity are often associated with em ergency or combined vascular and non vascular procedures. 2. When care full operative repair is performed with minimal dissection of structur es from the aneurysmal wall, excellent results can be expected. 3. Ure teral compression should be treated by ureteral stenting, preoperative ly, to facilitate ureterolysis or even to avoid it. Regular follow-up CT control is recommended.