Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2014
Immunoglobulin G4-related periaortitis complicated by aortic rupture and aortoduodenal fistula after endovascular AAA repair.
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Kasashima Satomi, Kawashima Atsuhiro, Kasashima Fuminori, Endo Masamitsu, Matsumoto Yasushi, Kawakami Kengo, Kayahara Masato, Ohta Hajime, Yano Masaaki, Marukawa Youhei
Аннотация
PURPOSE: To report a rare and complicated case of immunoglobulin (Ig) G4-related periaortitis involving both the aortic wall and the retroperitoneum without aneurysmal formation.
CASE REPORT: A 79-year-old man with IgG4-related periaortitis suffered aortic rupture despite a normal caliber aorta after 6 months of steroid therapy (20 mg/d). Endovascular repair with an aortic cuff sealed the rupture. Steroid therapy was halted 2 weeks later due to infection. Four months later, a biopsy during esophagogastroduodenoscopy to investigate gastrointestinal bleeding suggested a relapse of IgG4-RD in the duodenum. Subsequent aortoduodenal fistula formation proved fatal. Generally, IgG4-related periaortitis does not result in such complications due to the absence of aneurysm formation and a thick aortic wall.
CONCLUSIONS: Our report highlights a rare case of IgG4-related periaortitis where complications resulted following steroid therapy and surgical intervention, emphasizing the difficulties in dealing with IgG4-related cardiovascular lesions.
CASE REPORT: A 79-year-old man with IgG4-related periaortitis suffered aortic rupture despite a normal caliber aorta after 6 months of steroid therapy (20 mg/d). Endovascular repair with an aortic cuff sealed the rupture. Steroid therapy was halted 2 weeks later due to infection. Four months later, a biopsy during esophagogastroduodenoscopy to investigate gastrointestinal bleeding suggested a relapse of IgG4-RD in the duodenum. Subsequent aortoduodenal fistula formation proved fatal. Generally, IgG4-related periaortitis does not result in such complications due to the absence of aneurysm formation and a thick aortic wall.
CONCLUSIONS: Our report highlights a rare case of IgG4-related periaortitis where complications resulted following steroid therapy and surgical intervention, emphasizing the difficulties in dealing with IgG4-related cardiovascular lesions.
Предметные рубрики MeSH
AgedAortic Aneurysm, AbdominalAortic RuptureAortitisAortographyBiopsyBlood Vessel Prosthesis ImplantationDuodenal DiseasesEndoscopy, GastrointestinalEndovascular ProceduresEscherichia coli InfectionsFatal OutcomeGastrointestinal HemorrhageHumansImmunocompromised HostImmunoglobulin GIntestinal FistulaMaleRisk FactorsSteroidsTime FactorsTomography, X-Ray ComputedVascular Fistula