The Journal of cardiovascular surgery · 2026
Protocol-based medical management for inflammatory abdominal aortic aneurysms: a five-year single-center experience.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Hamzah Mohammad, Hayek Fadi, Sfeir Julien
Аннотация
BACKGROUND: Inflammatory abdominal aortic aneurysm (IAAA), a distinct clinical entity characterized by dense periaortic fibrosis and elevated inflammatory markers, lacks a consensus-driven optimal management strategy. While medical therapy is often utilized, comparative data against surgical or endovascular interventions remain limited. We report our experience with a standardized medical protocol for the management of IAAAs.
METHODS: We conducted a retrospective cohort study of 27 consecutive patients diagnosed with IAAA between 2012 and 2019. Predefined diagnostic criteria for IAAA included an ESR>100 mm/h, aortic wall thickness >10 mm, and inflammatory symptoms. Risk of rupture was assessed using a PET-CT scan for patients with a maximal aortic diameter exceeding 5.5 cm. A standardized medical protocol was used for low rupture risk patients including IV methylprednisolone followed by oral prednisone taper. Methotrexate was introduced for steroid-refractory cases. Endovascular or open aortic repair was used for patients with high risk of rupture.
RESULTS: Patients had a mean age of 62.3 years, and 70.4% were male. The mean baseline aortic diameter was 48±5 mm (95% CI 46.0-50.0). Twenty-three patients (85.2%) were treated initially with corticosteroids. At the 3-month mark, 69.6% of medically treated patients achieved an acceptable response with steroids alone. Five steroid-refractory patients received methotrexate and demonstrated clinical improvement. ESR normalized in 95.7% of medically treated patients. During five-year follow-up, no medically managed patient required emergency surgical intervention. Eleven patients required temporary steroid reintroduction at 3 years, with sustained stability at 5 years. Three patients underwent EVAR with favorable outcomes. One patient underwent open repair, which was associated with significant perioperative morbidity and late mortality.
CONCLUSIONS: In selected patients with low risk of aortic rupture, protocol-based medical therapy for IAAA is safe and effective with minimal risk upon mid-term follow-up. PET-CT scan assessment for risk of immediate rupture is appropriate for patients with aortic diameter between 5.5 to 6.5 cm. Methotrexate introduction may be effective for steroid-refractory cases. Endovascular repair remains a suitable option when intervention is required. Larger prospective studies are needed to establish definitive management guidelines for IAAAs.
METHODS: We conducted a retrospective cohort study of 27 consecutive patients diagnosed with IAAA between 2012 and 2019. Predefined diagnostic criteria for IAAA included an ESR>100 mm/h, aortic wall thickness >10 mm, and inflammatory symptoms. Risk of rupture was assessed using a PET-CT scan for patients with a maximal aortic diameter exceeding 5.5 cm. A standardized medical protocol was used for low rupture risk patients including IV methylprednisolone followed by oral prednisone taper. Methotrexate was introduced for steroid-refractory cases. Endovascular or open aortic repair was used for patients with high risk of rupture.
RESULTS: Patients had a mean age of 62.3 years, and 70.4% were male. The mean baseline aortic diameter was 48±5 mm (95% CI 46.0-50.0). Twenty-three patients (85.2%) were treated initially with corticosteroids. At the 3-month mark, 69.6% of medically treated patients achieved an acceptable response with steroids alone. Five steroid-refractory patients received methotrexate and demonstrated clinical improvement. ESR normalized in 95.7% of medically treated patients. During five-year follow-up, no medically managed patient required emergency surgical intervention. Eleven patients required temporary steroid reintroduction at 3 years, with sustained stability at 5 years. Three patients underwent EVAR with favorable outcomes. One patient underwent open repair, which was associated with significant perioperative morbidity and late mortality.
CONCLUSIONS: In selected patients with low risk of aortic rupture, protocol-based medical therapy for IAAA is safe and effective with minimal risk upon mid-term follow-up. PET-CT scan assessment for risk of immediate rupture is appropriate for patients with aortic diameter between 5.5 to 6.5 cm. Methotrexate introduction may be effective for steroid-refractory cases. Endovascular repair remains a suitable option when intervention is required. Larger prospective studies are needed to establish definitive management guidelines for IAAAs.