“DE NOVO” PERIAORTITIS AFTER EVAR OR AORTOILIAC STENTING: A SYSTEMATIC REVIEW
Chronic periaortitis and retroperitoneal fibrosis are related entities that develop with periaortic inflammation and deposition of fibroinflammatory tissue in the retroperitoneal space. This pathological fibroinflammatory process may be associated with endovascular treatment of abdominal aortic aneurysms (EVAR) as well as the treatment of aortoiliac arterial occlusive disease with stent/stent-graft implantation. We performed a systematic review of the literature in the MEDLINE database of original articles that documented the development of periaortitis after endovascular aortoiliac treatment for occlusive and aneurysmatic arterial disease. We included a total of 12 articles describing 14 cases of this complication. Most of the reported cases are related to the development of periaortitis after EVAR in the treatment of abdominal aortic aneurysms (AAA). The majority of patients are male, with ages ranging from 45 to 78 years. This complication was verified with the use of different devices that included nitinol or stainless-steel stents. In the case of stent-grafts this complication occurred with both polyester and polytetrafluoroethylene (PTFE) coverings. The severity of the clinical picture was also highly variable, with some cases presenting with hydronephrosis resulting from urethral obstruction. Treatment with corticotherapy, tamoxifen, or a combination of the two was effective in all cases. Periaortitis is an extremely rare complication of aortoiliac endovascular treatment. Similar to idiopathic retroperitoneal fibrosis, corticosteroid therapy appears to be highly effective and early treatment seems to be essential to avoid complications.
2. Palmisano A, Vaglio A. Chronic periaortitis: a fibro-inflammatory disorder. Best Pract Res Clin Rheumatol. 2009;23(3):339-353.
3. Adnan S, Bouraoui A, Mehta S, Banerjee S, Jain S, Dasgupta B. Retroperitoneal fibrosis; a single-centre case experience with literature review. Rheumatol Adv Pract. 2019;3(1):rky050.
4. Vaglio A, Maritati F. Idiopathic Retroperitoneal Fibrosis. J Am Soc Nephrol. 2016;27(7):1880-1889.
5. Urban ML, Palmisano A, Nicastro M, Corradi D, Buzio C, Vaglio A. Idiopathic and secondary forms of retroperitoneal fibrosis: a diagnostic approach. Rev Med Interne. 2015;36(1):15-21.
6. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
7. Simons PC, van Overhagen H, Bruijninckx CM, Kropman RF, Kuijpers KC. Periaortitis with ureteral obstruction after endovascular repair of an abdominal aortic aneurysm. AJR Am J Roentgenol. 2002;179(1):118-120.
8. Jetty P, Barber GG. Aortitis and bilateral ureteral obstruction after endovascular repair of abdominal aortic aneurysm. J Vasc Surg. 2004;39(6):1344-1347.
9. Brouw LW, van Weerelt CT, van Guldener C, Geenen GP, van der Laan L. Non invasive treatment of peri-aortic inflammation after endovascular graft. Eur J Vasc Endovasc Surg. 2007;34(2):179-181.
10. Vijaynagar B, McMahon GS, McCarthy MJ. Periaortic inflammation after endovascular aneurysm repair. Ann Vasc Surg. 2011;25(4):558 e555-557.
11. Taguchi T, Katayama K, Sueda T. Periaortic inflammation after endovascular graft. Asian Cardiovasc Thorac Ann. 2016;24(2):223.
12. Alomran F, de Blic R, Mallios A, Costanzo A, Boura B, Combes M. De novo periaortic fibrosis after endovascular aortic repair. Ann Vasc Surg. 2014;28(2):493 e491-493.
13. Frech A, Gratl A, Fraedrich G, Glodny B, Klocker J. Periaortitis as a rare complication after endovascular aneurysm repair. Circulation. 2015;131(16):1459-1461.
14. Mansour W, Capoccia L, Garofano R, Pranteda C, Speziale F. Early onset of periaortic inflammation after EVAR with inferior vena cava involvement: a case report. Ann Vasc Surg. 2015;29(1):127 e121-124.
15. Trinder M, Mwipatayi BP, Siew T, Lim A, Altaf N. Novel Management of Peri-Aortitis after Endovascular Repair of Abdominal Aortic Aneurysm. EJVES Short Rep. 2019;45:34-37.
16. Sapoval MR, Gaux JC, Long AL, et al. Transient periprosthetic thickening after covered-stent implantation in the iliac artery. AJR Am J Roentgenol. 1995;164(5):1271-1273.
17. Sakr G, Cynk M, Cowie AG. Retroperitoneal fibrosis: an unusual complication of intra-arterial stents and angioplasty. Br J Urol. 1998;81(5):768-769.
18. Mendes D, Machado R, Rego D, Ferreira V, Gonçalves J, Teixeira G et al. Fibrose retroperitoneal secundária à colocação de stents aorto-ilíacos: a propósito de 2 casos clínicos. Angiol Cir Vasc. 13(3), 62-67.
19. Sterpetti AV, Hunter WJ, Feldhaus RJ, et al. Inflammatory aneurysms of the abdominal aorta: incidence, pathologic, and etiologic considerations.
J Vasc Surg. 1989;9(5):643-649; discussion 649-650.
20. Paravastu SC, Ghosh J, Murray D, Farquharson FG, Serracino-Inglott F, Walker MG. A systematic review of open versus endovascular repair of inflammatory abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2009;38(3):291-297.
21. Maeda H, Umezawa H, Hattori T, et al. Early and late outcomes of inflammatory abdominal aortic aneurysms: comparison with the outcomes after open surgical and endovascular aneurysm repair in literature reviews. Int Angiol. 2013;32(1):67-73.
22. van Bommel EF, van der Veer SJ, Hendriksz TR, Bleumink GS. Persistent chronic peri-aortitis ('inflammatory aneurysm') after abdominal aortic aneurysm repair: systematic review of the literature. Vasc Med. 2008;13(4):293-303.
23. Ezimora A, Faulkner ML, Adebiyi O, Ogungbemile A, Marianna SV, Nzerue C. Retroperitoneal fibrosis: a rare cause of acute renal failure. Case Rep Nephrol. 2012;2012:645407.
24. Vaglio A, Pipitone N, Salvarani C. Chronic periaortitis: a large-vessel vasculitis? Curr Opin Rheumatol. 2011;23(1):1-6.
25. Clark CP, Vanderpool D, Preskitt JT. The response of retroperitoneal fibrosis to tamoxifen. Surgery. 1991;109(4):502-506.
26. Vaglio A, Palmisano A, Alberici F, et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomised controlled trial. Lancet. 2011;378(9788):338-346.
27. Bruggink JL, Slart RH, Pol JA, Reijnen MM, Zeebregts CJ. Current role of imaging in diagnosing aortic graft infections. Semin Vasc Surg. 2011;24(4):182-190.