When surgical repair is not feasible or appropriate, medical management based on current evidence guides treatment for patients with inflammatory abdominal aortic aneurysm.
Patients at high surgical risk, with a mantle sign on computed tomography angiography suggesting peri-operative difficulties, an aneurysm below the threshold for repair, technical inoperability, or unwillingness to undergo surgery.
The evidence-based approach for this scenario involves corticosteroid therapy as the primary intervention. The specific agent, dosing regimen, and treatment course are detailed in the full structured protocol.
Complete regimen — drug selection, dose, and duration — is available in the full protocol below.
Complete pain relief and erythrocyte sedimentation rate (ESR) within normal limits after a few weeks, with reduction of peri-aortic inflammation within 6 to 18 months.
DOI: 10.1016/j.ejvs.2023.01.003
Medical management based on the current literature is often considered in patients at high surgical risk, with a mantle sign suggesting peri-operative difficulties, or those below the threshold for repair with or without symptomatic aneurysms (pain, weight loss, or hydronephrosis).
Only Baskerville et al.18 published the results of five patients treated with corticosteroids alone (prednisone 50 mg twice daily for between 9 e 23 months), because of technical inoperability or the patients' unwillingness to undergo surgery.
This treatment led to complete pain relief and an ESR within normal limits after a few weeks, and reduction of peri-aortic inflammation within 6 e 18 months without any recurrence during follow up.
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