The principal imaging modality used for the diagnosis of an iAAA is CT (Figure 1). With contrast enhancement, this imaging technique has a sensitivity rate of 83%, with specificity and accuracy rates of 100% and 94%, respectively. In the majority of cases, the periaortic fibrotic plaque is well defined and of soft tissue density. Thickening of the aneurysm wall is most prominent in the anterolateral wall, with relative sparing of the posterior wall. There are no randomized trial data addressing the comparative role of open surgical and endovascular repair in patients with iAAAs. The majority of data derive from small series or case reports (Table 1). In pooled data from 999 open surgical repairs and 121 endovascular aneurysm repairs (EVARs) the 30-day mortality was 6.2% and 2.4%, respectively. The feasibility and safety of EVAR of iAAAs were also demonstrated in a recent meta-analysis of 14 studies, where technical success was achieved in 44 (96%) of 46 patients. At a mean follow-up of 18 months, aneurysm-related mortality was 0% and all-cause mortality was 13%. TABLE 1 Summary of Published Series of Endovascular Repair of Inflammatory Abdominal Aortic Aneurysm∗
Endovascular Treatment of Inflammatory Abdominal Aortic Aneurysms
Clinical Features
Endovascular Management
HYDRONEPHROSIS
Study
Year
Number of Patients
Follow-up
Before
After
Endoleak
Deaths in Follow-up
Vallabhaneni
2001
6
18
2
3
1
1
Hinchliffe
2002
14
29
6
5
1
3
Deleersnijder
2002
7
29
5
3
0
—
Lange
2005
52
23
5
5
9
1
Faizer
2005
6
20
1
—
0
0
Hechelhammer
2005
10
33
3
0
4
—
Puchner
2006
8
24
2
1
2
2
Coppi
2010
9
69
3
3
0
4
Total
—
112
31
27
20
17
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