o:2823 Inflammatory abdominal aortic aneurysm and retroperitoneal fibrosis Inflamatorna aneurizma abdominalne aorte i retroperitonealna fibroza en SUMMARY: The inflammatory aneurysm of abdominal aorta (IAAA) accounts for 3–11% of all abdominal aortic aneurysms, and occurs predominantly in men. It has similar pathological mechanisms like idiopathic retroperitoneal fibrosis (IRF) and perianeurysmal retroperitoneal fibrosis (PRF), thus presenting the same non-specific systemic inflammatory disorder known as chronic periaortitis (CP). Recognition of CP early in its course is important in order to reduce morbidity due to complications, such as renal failure and mortality from aortic rupture. However, the initial symptoms of CP are non-specific, which makes early clinical diagnosis extremely difficult. Various studies have shown favorable outcomes following corticosteroid treatment in nearly 90% of patients. The positive effects of adding different immunosuppressants to corticoid therapy have established such “duo-therapy” as a durable treatment option. Also, cessation of smoking has a positive effect on disease course and it should be an integral part of every treatment regimen. Operative repair of the abdominal aortic aneurysm is considered to be the definitive treatment for IAAA. The effects of both open and endovascular interventions on the inflammatory component however remain unclear. Resolution of periaortic fibrotic tissue after surgery for IAAA is still debated. Some investigators have reported a complete resolution while the others have noted partial regression and even persistence of the inflammatory cuff. Current treatment strategies are based upon “the best available evidence’’, mostly derived from clinical experience obtained by case series involving a small number of patients. Studies of a higher evidence level are very much needed to adjust our approach to such patients and to establish guidelines for treating this complex and serious disorder. SAŽETAK: Inflamatorne aneurizme čine 3-11% svih aneurizmi abdominalne aorte (AAA), javljajući se pretežno u muškaraca. Patofiziološki mehanizam nastanka ovih aneurizmi isti je kao i kod idiopatske i perianeurizmalne retroperitonealne fibroze, čineći tako nespecifični sistemski inflamatorni entitet poznat kao hronični periaortitis. Rano prepoznavanje ovog stanja važno je sa aspekta smanjenja morbiditeta i mortaliteta, pre svega otkazivanja bubrega i rupture aneurizme aorte. Mnoge studije su pokazale značaj tretmana preparatima kortikosteorida, dovodeći do željenih efekata u skoro 90% bolesnika. Dodavanjem različitih imunosupresivnih lekova postavljeni su osnovi „dualne terapije“ kao dugoročnog rešenja. Takođe, prekid pušenja pozitivno utiče na tok bolesti i predstavlja integralni deo svakog režima lečenja. Iako se smatra da je operativno lečenje AAA definitivna terapijska opcija, efekti otvorene i endovaskularne hirurgije na inflamatornu komponentu AAA ipak ostaju nerazjašnjeni. Rezolucija periaortnog fibroznog tkiva nakon hirurškog lečenja i dalje ostaje predmet debate. Neki autori su prijavilni potpunu rezoluciju, dok su drugi primetili parcijalnu regresiju uz perzistirajući paraaortalni „cuff“. Trenutne strategije lečenja bazirane su na osnovu „najboljih dostupnih dokaza“, uglavnom dobijenih iz kliničkog iskustva baziranog na individualnim slučajevima i istraživanjima sa malim brojem pacijenata. Studije od većeg kliničkog značaja su neophodne kako bismo prilagodili pristup takvim pacijentima i formirali vodiče za lečenje ovog kompleksnog i ozbiljnog poremećaja. Key words: inflammatory abdominal aortic aneurysm, retroperitoneal fibrosis, chronic periaortitis, corticosteroids, immunosuppressants, abdominal aortic surgery, EVAR Ključne reči: inflamatorna aneurizma abdominalne aorte, retroperitonealna fibroza, hronični periaortitis, kortikosteroidi, imunosupresivi, hirurgija abdominalne aorte, EVAR 91552100 125841417 1552101 0301-0619 1552099 10.5937/MedIst1701001N 2023-09-27T09:47:14.232Z 44 yes 46 Mihailo Nešković 29988455 0000-0003-4829-985X 2017 46 Nenad Đukić 29990247 2017 46 Alexander Rakic 46 Đorđe Radak 12465767 0000-0003-3199-5613 2017 application/pdf 506290 https://unilib.phaidrabg.rs/o:2823 no yes 16 Licenca na osnovu podataka preuzetih sa https://scindeks.ceon.rs/JournalDetails.aspx?issn=0301-0619 70 616.136‑007.64 92000001 71A11 Medicinska istraživanja 1 51 1 8 2017