[Inflammatory aneurysm of the abdominal aorta and its complications: report of 2 clinical cases].

The authors present two cases of inflammatory abdominal aortic aneurysms complicated by an aorto-caval fistula in one case and by an aorto-duodenal fistula in the other. The aetiology of such aneurysms is still debatable, the histological features are typical, and the preoperative clinical and instrumental findings do not always allow them to be differentiated from atherosclerotic ones. The complications may be rapidly fatal or asymptomatic, as in the case of occult aorto-caval fistulas. The surgical approach is technically more difficult because of inflammation and adhesions between the aneurysmal sac and contiguous structures which make dissection and aorto-iliac clamping more demanding. In the case of aorto-caval fistulas, clamping of the vein should be avoided and manual compression preferred to assure haemostasis; with aorto-enteric fistulas, it is necessary to reduce the contamination of the operative field. Ureterolysis is not always necessary in patients with hydronephrosis. Endovascular devices may be an alternative also for a number of complications.