|previous article in this issue|
Document Details :
Title: Progressieve zeurende onderbuikpijn ... een zeldzame diagnose
Author(s): DE BRUCKER N, DE BUCK A, VANNESTE L, VAN LYSEBETH L, CEUPPENS H, D’HEYGERE F
Journal: Tijdschrift voor Geneeskunde
Volume: 66 Issue: 5 Date: 2010
Peri-aortitis five years after insertion of a stent graft for an infrarenal aneurysm: case report of a rare complication
A 77-year-old patient with an infrarenal aneurysm was treated by insertion of a bifurcated stent graft (Talent®, Medtronic) in 2003 at the AZ Groeninge Hospital, Kortrijk (Belgium). There were no postoperative complications and the follow-up was uneventful.
After 5 years, he presented with abdominal discomfort, anorexia and subfebrillitas. Biochemical investigation revealed an increased erythrocyte sedimentation rate with a normal leucocytosis and a slightly decreased renal function. In comparison to previous CT scans, a new CT of the abdomen revealed thickening of the aneurysmal wall. Involvement of the ureters was not seen. A PET scan confirmed the diagnosis of an inflammatory aneurysm. Treatment with i.v. cortisone resulted in a spectacular regression of symptoms and normalisation of the biochemistry and radiology.
Only four cases with the development of a symptomatic periaortitis after stent graft placement have – to the best of our knowledge – been reported in the literature. All patients were treated with cortisone and/or tamoxifen with an entire regression of the inflammation. Actually the mechanisms of the development of a periaortitis are incompletely understood. 3 to 10% of the aortic aneurysms are inflammatory, with a higher male incidence. Surgery remains the treatment of choice for inflammatory aneurysms (IAAA), the periaortitis regressing in 53% of the cases with open surgery and much less with EVAR. CT-imaging reveals an induction of periaortitis in 18% of the patients who have been treated with EVAR, though without any clinical significance. In some cases, as in our patient, a significant periaortitis develops, requesting drug-therapy to control the disease.