Surgical treatment of recurrent abdominal aortic aneurysm in a patient with systemic lupus erythematosus

A, First CT revealed infrarenal AAA that was 4 cm in diameter. B, Next CT 3 months after the first one revealed that the aneurysm grew to 8 cm in diameter with an irregular shape. C, The size of the residual abdominal aorta was within normal limits a year after the first operation. D, Five months after the last one, CT revealed a recurrent aneurysm with atheroma on the right side in the vicinity of the proximal anastomosis. It was 4.5 cm in diameter and irregular in shape.

A, Angiography showed the AAA to be located near the proximal anastomosis involving the left renal artery and barely sparing the right renal artery. B, Postoperative angiography revealed good patency of the renal arteries.

A, The wall of the AAA showed irregular thickening with intimal fibrin thrombus and medial inflammatory cell infiltrate (arrowheads ) accompanied by vascularization. Hematoxylin-eosin stain. Scale bar, 1 mm. B, Higher magnification of the media seen in A. Small vessels are irregularly running among smooth muscle cells, and focal hyalinization and elastic fiber splitting are also seen. Lymphocytes have infiltrated the perivascular space and are scattered among smooth muscles. Hematoxylin-eosin stain. Scale bar, 100 μm.