Clinical Management of Peri-Aortitis Following Endovascular Aortic Repair for Abdominal Aortic Aneurysm

<b>Objectives:</b> Peri-aortitis following endovascular aneurysm repair (EVAR) is a rare phenomenon with unclear pathogenesis. In this study, we investigated its clinical features and sac prognosis. <b>Methods:</b> A retrospective analysis was conducted on 1369 EVAR. Peri-aortitis was defined using post-EVAR computed tomography. Clinical and imaging data were assessed. <b>Results:</b> Peri-aortitis following EVAR was identified in 12 patients (0.89%) with a mean age of 74 ± 8.9 years; 83.3% were male, and 41.7% had allergic or autoimmune histories. There were eight symptomatic cases (66.7%), including seven with fever, three with back or abdominal pain, and one with hydronephrosis. Precautionary antibiotic treatment was administered in five febrile cases. Although persistent and recurrent inflammation was observed in two cases (16.7%) each, inflammation resolved spontaneously in seven patients (58.3%). One (8.3%) needed steroid therapy for severe back pain. Aneurysm shrinkage was observed in seven cases (58.3%), while enlargement was noted in one case (8.3%) with type II endoleak. No correlation was found between aneurysm growth and peri-aortitis development. <b>Conclusions:</b> Peri-aortitis following EVAR may present significant challenges, including differentiation from infection, management of symptomatic cases requiring medical therapy, and addressing recurrences. Accurate diagnosis, individualized treatment, and meticulous follow-up are essential for favorable outcomes.