Investigation and treatment of a complicated inflammatory aortoiliac aneurysm.
Inflammatory abdominal aortic aneurysms (IAAAs) account for 5% to 10% of all abdominal aortic aneurysms, occurring primarily in males. Their true etiology is unknown. Symptoms and signs of IAAA are so variable that they present to a wide range of specialties. There is debate in the literature whether IAAA is a manifestation of systemic autoimmune disease. We describe the case of a young female patient with complicated inflammatory aortoiliac aneurysmal disease, illustrating diagnostic and treatment challenges that remain. Our patient had a positive autoantibody screen, raised erythrocyte sedimentation rate, positive enzyme-linked immunosorbent spot test, and saccular aneurysms, including infective and inflammatory etiologies in her differential diagnosis. Early diagnosis is crucial to limit disease progression, morbidity, and mortality. Medical management is important to address the underlying disease process, but a combination of endovascular and open surgical intervention is often necessary for definitive treatment. Available evidence offers plausibility for benefit of endovascular intervention over open repair.
Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK. j.shalhoub@imperial.ac.uk
Maresa A
MA
Brake
Joseph
J
Shalhoub
Jeremy S
JS
Crane
Richard G J
RG
Gibbs
Ian J
IJ
Franklin
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001025:Aortitis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001323:Autoantibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents