Inflammatory abdominal aortic aneurysm: when corticosteroid therapy has not achieved remission
Clinical scenario
Corticosteroids are the first-line treatment for inflammatory abdominal aortic aneurysm — initiated at high dose to control the acute inflammatory process, then progressively tapered over time. When this initial course does not achieve its expected clinical benchmarks, an escalation pathway becomes necessary.
Why corticosteroids were not sufficient
Prior therapy: Corticosteroids — high-dose initiation to induce remission, with dose reduction following control of the acute inflammatory process over approximately one year.
Goals not reached (triggers escalation to this protocol)
Complete pain relief and erythrocyte sedimentation rate (ESR) within normal limits within a few weeks, and reduction of peri-aortic inflammation within 6–18 months.
Next-line approach — overview
When the aneurysm meets the size criterion for intervention, surgical repair becomes indicated. The choice between available surgical approaches depends on the patient's anatomy and suitability — with one technique considered the preferred first-line option for appropriate candidates and an alternative open approach available otherwise.
Goal: successful aneurysm exclusion
References
DOI: 10.1016/j.ejvs.2023.01.003
- According to the European Society of Vascular Surgery 2019 AAA guidelines, "EVAR should be considered as a first line option in anatomically suitable patients".
- Surgical intervention is indicated at the same threshold as for degenerative AAAs (aneurysm diameter 55 mm).
- Technical success was defined as completion of the implantation of the aortic graft and successful aneurysm exclusion for open surgical repair (OSR), and according to the reporting standards for endovascular aneurysm repair (EVAR).
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