Management of an inflammatory abdominal aortic aneurysm causing ureteric obstruction: a case report

Inflammatory abdominal aortic aneurysms (IAAAs) are rare large-vessel pathology, with potentially life-threatening complications including obstructive uropathy secondary to retroperitoneal fibrosis. Comprising a small proportion of all AAA, their pathogenesis remains unknown, with the hypothesis of infective and immunological aetiologies circulating in current literature. Management principles of IAAAs aim at prevention of aortic rupture and include open-surgical or endovascular therapies. Due to their involvement of other structures, additional considerations are needed when approaching their management for optimal patient outcomes. We present the case of a 53-year-old otherwise healthy male with a large IAAA complicated by adjacent ureteric obstruction, successfully treated with ureteric stenting and delayed endovascular aortic aneurysm repair.

Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report

Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.