Efficacy of steroid therapy in the treatment of inflammatory abdominal aortic aneurysms

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.