Periaortitis following endovascular aneurysm repair – A case report and review of literature

Abstract

Endovascular aneurysm repair (EVAR) is a minimally invasive well-described procedure used in the management of infrarenal abdominal aortic aneurysms (AAA). Periaortitis following EVAR is a rare but possible complication that must be considered during surveillance. We recount a case of a 77-year-old man who underwent an EVAR with coiling of the right internal iliac artery for an incidentally detected inflammatory AAA. Due to intractable lower back ache, fatigue, and low-grade fever that surfaced a month postoperatively, he was evaluated with inflammatory markers, Positron emission tomography-computed tomography angiograms which revealed features of periaortic inflammation and involvement of the right ureter and duodenum. He was managed with broad-spectrum antibiotics to which he responded albeit transiently. Persistent symptoms prompted us to start systemic corticosteroids as per body weight that was tapered over 2 months and ureteric stenting was offered. Management with corticosteroids, tamoxifen, and early stenting has been described in the reported literature. His symptoms improved dramatically and the evidently high inflammatory markers also reduced. Keen monitoring and early management with steroids of periaortitis following EVAR is a prudent paradigm to be implemented.

Keywords

• endovascular aneurysm repair
• periaortitis
• surveillance