Inflammatory abdominal aortic aneurysm
ICD-10 I71.4 · ICD-11 BD50.4Y

When Corticosteroids Alone Have Failed in High-Surgical-Risk Inflammatory Abdominal Aortic Aneurysm

Clinical scenario

Medical management is considered for patients at high surgical risk, with a mantle sign on computed tomography angiography suggesting peri-operative difficulties, or those with an aneurysm below the threshold for repair. It also applies in cases of technical inoperability or unwillingness to undergo surgery.

Prior treatment — indication for escalation

The preceding line used corticosteroids alone. Escalation to this protocol is indicated when that approach fails to achieve: complete pain relief and erythrocyte sedimentation rate (ESR) within normal limits within a few weeks, or reduction of peri-aortic inflammation within 6–18 months.

Next-step treatment (partial overview)

The protocol involves alternative immunosuppressive agents — distinct from corticosteroid monotherapy — or hormonal modulation, which may be used alone or in combination with steroids. The complete regimen and individualised sequencing are available via the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

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.

Other immunosuppressive drugs (i.e., mycophenolate mofetil, azathioprine, cyclophosphamide, tocilizumab, and methotrexate)47 and anti-oestrogen treatment (tamoxifen)48 have been used alone or combined with steroids.

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