Retroperitoneal fibrosis secondary to the placement of aorto-iliac stents: 2 clinical cases.

  • Daniel Azevedo Mendes Centro Hospitalar Universitário do Porto
  • Rui Machado
  • Duarte Rego
  • Vitor Ferreira
  • João Gonçalves
  • Gabriela Teixeira
  • Inês Antunes
  • Carlos Veiga
  • Rui Almeida
Keywords: Retroperitoneal fibrosis; Stent; Endoprosthesis; Abdominal aortic aneurysm

Abstract

Abstract

Retroperitoneal fibrosis (RF) is a rare disease, characterized by inflammation and fibrosis in the periphery of the abdominal aorta which spreads within the retroperitoneal space, invading adjacent structures. In about two thirds of the cases this condition is idiopathic presenting a secondary cause in the rest. In the majority of cases, secondary forms are associated with drugs and neoplasia, but there are more situations that can lead to the development of the disease. Recently, evidence has emerged that RF is related with angioplasty, stenting or implantation of endoprosthesis in aortoiliac axes, however, literature is very scarce. We present our experience with two patients with grade IIb arteriopathy, one with preocclusive stenosis of the left common iliac artery treated with angioplasty and stenting of the lesion, other with morphologically significant stenosis of the infrarenal abdominal aorta where angioplasty and placement of two covered aortoiliac endoprostheses in the form of kissing the stent was performed. Both patients have manifested marked lumbar pain with a periaortic inflammatory process suggestive of retroperitoneal fibrosis visualized in CT angiography that evolved to abdominal inflammatory aortic aneurysm. The pathophysiology of this findings is not known; however, we may assume that angioplasty and stenting can disturb plaque integrity with antigen exposure triggering a local inflammatory response. On the other hand, an immune reaction directly against the stent may arise. It is important to think about this occurrence, since there is a good response to steroid therapy in this patients and because of the possible progression to inflammatory aortic aneurysm.

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Published
2020-03-25
Section
Clinical Case

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