Inflammatory aneurysms of the abdominal aorta involving the ureters: Is combined treatment really necessary?

Purpose: Peri-aneurysmal fibrosis complicating inflammatory aneurysm of the abdominal aorta may involve the ureters, causing urological complications. We assessed patient anatomical and clinical outcomes after conservative ur eteral management. Materials and Methods: From the operative records of 1,271 consecutive pati ents who underwent surgical repair of abdominal aortic aneurysms from 1980 to 1999 we identified 77 (6%) who had inflammatory aneurysms, which were co mplicated in 19 (24.6%) by dense peri-aneurysmal and ureteral fibrosis, Of these 19 patients 15 (78.9%) had coexisting monolateral hydronephrosis, 3 ( 15.7%) had bilateral hydronephrosis and 1 (5.2%) had renal atrophy. In 14 c ases (73.6%) the fibrotic reaction severely impaired renal function. Only 1 patient underwent an emergency operation, while the others underwent elect ive repair. Only 2 patients (10.5%) underwent a specific urological procedu re, including bilateral nephrostomy in 1 and ureterolysis plus ureterolitho tomy in 1, Most ureteral complications were treated conservatively by aneur ysmectomy only. Results: Immediate postoperative mortality was 7% (1 of 14 cases). Median f ollowup was 48 months. In 1 of the 13 cases (7.7%) a ureteral stent was pla ced during followup. After aneurysmectomy in 9 of the 12 patients (75%) wit h renal dysfunction periaortic fibrosis disappeared or decreased as well as associated hydronephrosis. In 11 of the remaining 12 patients (91%) of the 14 with renal failure preoperatively kidney function returned to normal or improved. In the 2 patients who underwent a specific urological procedure renal function improved but did not return to normal. Conclusions: Inflammatory abdominal aortic aneurysms involving the ureters and compressing the urinary structures respond well to aneurysmal resection only without a urological procedure.