Surgical repair of inflammatory abdominal aortic aneurysms

Background

An aneurysm is a localised widening or enlargement of an artery that may ultimately lead to rupture (bursting) and may be fatal. The abdominal aorta is the artery most frequently involved in the enlargement process. In inflammatory abdominal aortic aneurysms, the aortic enlargement is accompanied by inflammation around the aorta with thickening of the adjacent tissues and potential entrapping of the adjacent organs, mostly the ureters (the tubes draining the kidneys) or intestines, thus potentially causing kidney or bowel problems. The aim of aneurysm treatment is to prevent rupture. It can be accomplished by an open repair, which involves surgery to open the abdomen and replace the aneurysm with an artificial graft (tube), or by an endovascular repair, which places an artificial stent graft inside the aneurysm, delivered through the blood vessel in the groin. In inflammatory aneurysm, inflammation and involvement of the ureters or intestines make open repair more difficult. However, endovascular repair may not last as well and may not relieve the inflammation as much or may worsen it. It is currently unclear whether open repair or endovascular repair is the best treatment for inflammatory aortic aneurysm.

Key results

We searched for evidence directly comparing the treatments in inflammatory aortic aneurysm repair. The present review found no randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups; one of which is the control group), quasi-randomised controlled trials (clinical studies where people are not randomly put into one of two or more treatment groups; one of which is the control group; e.g. by date of birth) and controlled clinical trials (a clinical trial that has a control group but is not necessarily randomised) to determine the superiority of one treatment over the other. Further studies are needed to help surgeons chose the best treatment for inflammatory abdominal aortic aneurysms.

Authors' conclusions: 

We found no published RCTs, quasi RCTs or controlled clinical trials comparing open repair and elective endovascular repair for IAAA, assessing immediate (30-day), intermediate (up to one-year follow-up) and long-term (more than one-year follow-up) mortality or complications rates. High-quality studies evaluating the best treatment for inflammatory abdominal aneurysm repair are required.

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Background: 

Inflammatory abdominal aortic aneurysm (IAAA) is a rare but potentially life-threatening condition characterised by marked thickening of the aortic wall, peri-aneurysmal and retroperitoneal fibrosis, and dense adhesions of adjacent abdominal organs. The pathogenesis of IAAA remains an enigma. The main aim of invasive or surgical therapy of AAAs is prevention or correction of aortic rupture. Prevention or treatment of AAA rupture by open or endovascular repair is proven by numerous studies published in the literature. Treatment of IAAA poses a different challenge to surgeons compared with traditional atherosclerotic AAA because of the potential for iatrogenic injury in open repair or, alternatively, potential increased inflammatory response to endoprosthesis implantation.

Objectives: 

To assess the effects of elective endovascular versus open repair for inflammatory abdominal aortic aneurysms.

Search strategy: 

The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (April 2015) and the Cochrane Register of Studies (CRS) (2015, Issue 3). The TSC searched trial databases for details of ongoing and unpublished studies.

Selection criteria: 

We sought all published and unpublished randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials comparing results of elective endovascular or open repair of IAAAs without language restriction.

Data collection and analysis: 

Both review authors independently assessed studies identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.

Main results: 

We identified no studies that met the inclusion criteria.

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