IgG4-related Inflammatory Abdominal Aortic Aneurysm Developing 2 Years after Endovascular Aortic Repair

• Published in: Japanese Journal of Vascular Surgery Vol. 30; no. 4; pp. 225 - 228
• Main Author: Sumino, Satoshi
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 26.08.2021; 特定非営利活動法人 日本血管外科学会
• Subjects: endovascular aortic repair; IgG-related inflammatory abdominal aortic aneurysm; IgG4 related disease; IgG4関連炎症性腹部大動脈瘤; IgG4関連疾患; inflammatory abdominal aortic aneurysm; 炎症性腹部大動脈瘤; 腹部大動脈ステントグラフト
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.21-00022

We experienced a case of IgG4-related abdominal aortic aneurysm (IgG4-related IAAA) developing 2 years after endovascular aortic repair (EVAR) which was successfully treated by steroid administration. An 82 years old male who underwent EVAR has been regularly followed up at outpatient clinic. At 2 years follow-up post EVAR, inflammatory changes of abdominal aorta (Mantle sign) were accidentally identified by CT scan. Further investigation revealed IgG4 positive, then diagnosed as IgG4-related IAAA. He had no symptoms and there were not any complications of endoleak and/or migration of the stent graft except of 2 mm enlargement of aneurysm diameter, therefore, the surgical intervention did not seem necessary. Steroid administration therapy was commenced at starting dose 30 mg, then followed up by CT scan and laboratory evaluation. Thickened adventitia and periaortic tissue almost disappeared 2 months later. Steroid administration was reduced gradually down to 5 mg in 6 months. Serum IgG4 level was also normalized in 6 months. Neither recurrence of inflammatory abdominal aneurysm nor post EVAR complications have been detected at 1 year follow up stage.