Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture

• Published in: Journal of vascular surgery 2008-11, Vol.48 (5), p.1332-1334
• Main Authors: Edmonds, Rebecca D., MD, Tomaszewski, Jeffrey J., MD, Jackman, Stephen V., MD, Chaer, Rabih A., MD
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - methods; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - instrumentation; Cardiology. Vascular system; Diseases of the aorta; Female; Flank Pain - etiology; Flank Pain - surgery; Humans; Hydronephrosis - etiology; Hydronephrosis - surgery; Kidney Diseases - etiology; Kidney Diseases - pathology; Kidney Diseases - surgery; Medical sciences; Retroperitoneal Fibrosis; Rupture; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Adhesions; Tomography, X-Ray Computed; Treatment Outcome; Ureteral Obstruction - diagnostic imaging; Ureteral Obstruction - etiology; Ureteral Obstruction - surgery; Urologic Surgical Procedures - instrumentation; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.05.067

We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.