IgG4-related Inflammatory Abdominal Aortic Aneurysm Developing 2 Years after Endovascular Aortic Repair
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 y...
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| Published in | Japanese Journal of Vascular Surgery Vol. 30; no. 4; pp. 225 - 228 |
|---|---|
| Main Author | |
| 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 | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.21-00022 |
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| Abstract | 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. |
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| AbstractList | 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.
腹部大動脈瘤に対するステントグラフト内挿術施行2年後にIgG4関連炎症性腹部大動脈瘤を発症し，ステロイドによる内科治療が奏功した1例を経験した．患者は82歳，男性．他院で腹部大動脈瘤に対しEVARを施行され，以後当院外来でフォロー中，2年後のCTフォローにおいてMantle signを認め，炎症性大動脈瘤と診断，IgG4陽性であった．CT上EVAR後2 mmの瘤径拡大を除いてEndoleak, Migrationなどの異常所見は認めず，外科治療の適応なく，ステロイド投与による内科治療を選択した．ステロイドは30 mgから開始し，血液生化学検査での炎症所見とCT所見を指標に漸減した．CT上の瘤周囲肥厚所見はステロイド開始2カ月後にほぼ消退した．ステロイドは6カ月後に5 mgまで減量し，血清IgG4値も正常化した．1年経過した時点で炎症性大動脈瘤の再発はない．文献的考察を加え報告する． 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. |
| Author | Sumino, Satoshi |
| Author_FL | 角野 聡 |
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| PublicationTitle | Japanese Journal of Vascular Surgery |
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| Publisher | JAPANESE SOCIETY FOR VASCULAR SURGERY 特定非営利活動法人 日本血管外科学会 |
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| References | 2) 松本 康，笠島里美，川島篤弘，他．IgG4関連動脈周囲炎；心血管領域における新しい疾患概念．心臓2010; 42; 458–469. 6) Kasashima S, Kawashima A, Kasashima F, et al. Exacerbation of immunoglobulin G4-related inflammatory abdominal aortic aneurysm after endovascular repair. Pathol Int 2020; 70: 812–819. 4) Stone WM, Fankhauser GT, Bower TC, et al. Comparison of open and endovascular repair of inflammatory aortic aneurysm. J Vasc Surg 2012; 56: 951–956; discussion, 955–956. 8) Mizushima I, Inoue D, Yamamoto M, et al. Clinical course after corticosteroid therapy in IgG4-related aortits/periaortits and periarteritis: a retrospective multicenter study. Arthritis Res Ther 2014; 16: R156. 13) Prucha M, Sedivy P, Stadler P, et al. Addominal aortic aneurysm as an IgG4-related disease. Clin Exp Immunol 2019; 197: 361–365. 3) 日本循環器学会，日本心臓血管外科学会，日本胸部外科学会，日本血管外科学会．2020年改訂版 大動脈瘤・大動脈解離診療ガイドライン．https://www.j-circ.or.jp/cms/wp-content/uploads/2020/07/JCS2020_Ogino.pdf（参照：2021年3月3日） 12) Schürmann K, Vorwerk D, Bücker A, et al. Perigraft inflammation due to Dacron-covered stent-grafts in sheep iliac arteries: correlation of MR imaging and histopathologic findings. Radiology 1997; 204: 757–763. 9) van Bommel EFH, van der Veer SJ, Hendriksz TR, et al. Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature. Vasc Med 2008; 13: 293–303. 10) Trinder M, Mwipatayi BP, Siew T, et al. Novel management of peri-aortitis after endovascular repair of abdominal anortic aneurysm. EJVES Short Rep 2019; 45: 34–37. 1) IgG4関連全身硬化性疾患の診断法の確立と治療方法の開発に関する研究班，新規疾患，IgG4関連多臓器リンパ増殖性疾患（IgG4+MOLPS）の確立のための研究班．IgG4関連疾患包括診断基準2011．日内会誌2012; 101: 795–804. 5) Kasashima S, Kasashima F, Kawashima A, et al. Clinical outcomes after endovascular repair and open surgery to treat immunoglobulin G4-related and nonrelated inflammatory abdominal aortic aneurysms. J Endovasc Ther 2017; 24: 833–845. 7) Vaglio A, Palmisano A, Alberici F, et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomized controlled trial. Lancet 2011; 378: 338–346. 11) Frech A, Gratl A, Fraedrich G, et al. Periaortitis as a rare complication after endovascular aneurysm repair. Circulation 2015; 131: 1459–1461. |
| References_xml | – reference: 5) Kasashima S, Kasashima F, Kawashima A, et al. Clinical outcomes after endovascular repair and open surgery to treat immunoglobulin G4-related and nonrelated inflammatory abdominal aortic aneurysms. J Endovasc Ther 2017; 24: 833–845. – reference: 10) Trinder M, Mwipatayi BP, Siew T, et al. Novel management of peri-aortitis after endovascular repair of abdominal anortic aneurysm. EJVES Short Rep 2019; 45: 34–37. – reference: 7) Vaglio A, Palmisano A, Alberici F, et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomized controlled trial. Lancet 2011; 378: 338–346. – reference: 9) van Bommel EFH, van der Veer SJ, Hendriksz TR, et al. Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature. Vasc Med 2008; 13: 293–303. – reference: 4) Stone WM, Fankhauser GT, Bower TC, et al. Comparison of open and endovascular repair of inflammatory aortic aneurysm. J Vasc Surg 2012; 56: 951–956; discussion, 955–956. – reference: 13) Prucha M, Sedivy P, Stadler P, et al. Addominal aortic aneurysm as an IgG4-related disease. Clin Exp Immunol 2019; 197: 361–365. – reference: 11) Frech A, Gratl A, Fraedrich G, et al. Periaortitis as a rare complication after endovascular aneurysm repair. Circulation 2015; 131: 1459–1461. – reference: 1) IgG4関連全身硬化性疾患の診断法の確立と治療方法の開発に関する研究班，新規疾患，IgG4関連多臓器リンパ増殖性疾患（IgG4+MOLPS）の確立のための研究班．IgG4関連疾患包括診断基準2011．日内会誌2012; 101: 795–804. – reference: 2) 松本 康，笠島里美，川島篤弘，他．IgG4関連動脈周囲炎；心血管領域における新しい疾患概念．心臓2010; 42; 458–469. – reference: 3) 日本循環器学会，日本心臓血管外科学会，日本胸部外科学会，日本血管外科学会．2020年改訂版 大動脈瘤・大動脈解離診療ガイドライン．https://www.j-circ.or.jp/cms/wp-content/uploads/2020/07/JCS2020_Ogino.pdf（参照：2021年3月3日） – reference: 12) Schürmann K, Vorwerk D, Bücker A, et al. Perigraft inflammation due to Dacron-covered stent-grafts in sheep iliac arteries: correlation of MR imaging and histopathologic findings. Radiology 1997; 204: 757–763. – reference: 6) Kasashima S, Kawashima A, Kasashima F, et al. Exacerbation of immunoglobulin G4-related inflammatory abdominal aortic aneurysm after endovascular repair. Pathol Int 2020; 70: 812–819. – reference: 8) Mizushima I, Inoue D, Yamamoto M, et al. Clinical course after corticosteroid therapy in IgG4-related aortits/periaortits and periarteritis: a retrospective multicenter study. Arthritis Res Ther 2014; 16: R156. |
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| SubjectTerms | 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 |
| Title | IgG4-related Inflammatory Abdominal Aortic Aneurysm Developing 2 Years after Endovascular Aortic Repair |
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