Abstract
We reviewed the clinical experiences of 16 cases of inflammatory abdominal aortic
aneurysms (IAAA) to identify the efficacy of steroid therapy for patients with the
condition. The patient group consisted of 15 males and 1 female, ages from 53 to 81
(mean 67.4) years. Twelve of 16 patients (75.0%) had significant symptoms including
abdominal pain or backache, or weight loss. There were no cases of rupture. Preoperative
laboratory data showed elevation of ESR in 15 of 16 (93.8%) patients and positive
C-reactive protein (CRP) in 13 of 16 (81.3%) patients. Steroid therapy to reduce the
extent of inflammation was indicated for patients with (1) small aneurysms (diameter
<5 cm) with severe pain or weight loss, (2) associated intense hydronephrosis, or
(3) computed tomography (CT) findings of the highly thickened aneurysmal wall with
rigid adherence of adjacent structures, suggesting difficulty in performing operative
procedures. With these indications, steroid therapy was applied to 6 of 16 patients
(one case preoperatively, one postoperatively, and four without undergoing operation).
Steroid therapy was effective for attenuating inflammation in all six patients and
even for reducing the size of aneurysms in three patients. However, rapid increase
in the size of the aneurysm during steroid therapy was found in one patient, followed
by emergent operation of graft replacement. Although the possible increased risk of
rupture should be considered when using steroid therapy, our clinical experiences
showed the efficacy of steroid therapy in most cases, under limited indications.
