Fifteen-year experience of transperitoneal management of inflammatory abdominal aortic aneurysms

Objectives: to assess the long-term outcome of patients with inflammatory a bdominal aortic aneurysms. Materials and methods: over a fifteen-year period 598 cases of abdominal ao rtic aneurysm were treated and, of these, 32 cases (5.3%) were inflammatory in nature. The diagnosis was made on preoperative (CT) computed tomography in fifteen cases. Twenty-six patients were symptomatic on presentation and ten cases were repaired on an emergency basis. Only six were repaired elec tively. The transabdominal transaortic approach without dissection on the n earby adherent structures was used routinely. Results: there was one postoperative death from a respiratory arrest leadin g to a thirty-day mortality of 3.1%. Early graft thrombosis occurred in thr ee cases (9.3%) and all underwent successful thrombectomy. Colonic ischaemi a was encountered in one patient who later developed an aortoenteric fistul a. Two patients suffered a non-fatal myocardial infarction postoperatively leading to an overall morbidity of 18.7%. Conclusions: patients with inflammatory aortic aneurysms fare worse than pa tients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an ante rolateral aortotomy and minimal dissection of adherent structures offers ex cellent results in dealing with this difficult group of patients.