{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:29Z","timestamp":1787027369311,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early diagnosis and treatment of under-recognized retroperitoneal fibrosis (RPF) are essential before reaching the poorly responsive fibrotic stage. Although most patients respond to medical therapy, relapses and unresponsiveness are common. However, open surgery in medically resistant patients is associated with major adverse clinical events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a single-centre longitudinal study of optimal medical therapy (OMT) vs. endovascular aneurysm repair (EVAR) in patients presenting with RPF to our tertiary referral vascular centre. Out of 22,349 aortic referrals, we performed 1,555 aortic interventions over twenty years. Amongst them, 1,006 were EVAR, TEVAR and BEVAR. Seventeen patients (1.09%) had documented peri-aortic RPF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of the 17 RPF patients, 11 received OMT only, while 6 underwent EVAR after the failure of OMT. 82% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914) were male, and the median follow-up was 62.7 months (IQR: 28.2\u2013106). Nine (52%) had immunoglobulin G4-related disease (4 OMT vs. 5 EVAR). EVAR patients had 100% technical success without perioperative mortality. Furthermore, all the EVAR patients were symptom-free following the intervention. Pre-operative aortic RPF index (maximum peri-aortic soft tissue diameter\/maximum aortic diameter) was higher in the EVAR than in OMT. However, there was a significant decrement in the aortic RPF index following EVAR (\n                      <jats:italic>P\u2009<\/jats:italic>\n                      =\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We believe that when optimal medical therapy fails in RPF, EVAR provides a promising outcome. Further studies are recommended to establish the role of endovascular repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2022.946675","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T04:23:51Z","timestamp":1658204631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of retroperitoneal fibrosis with endovascular aneurysm repair in patients refractory to medical management"],"prefix":"10.3389","volume":"9","author":[{"given":"Sherif","family":"Sultan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh","family":"Acharya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohieldin","family":"Hezima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Ramjohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Miresse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keegan","family":"Chua Vi Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Soliman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niamh","family":"Hynes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"B1","first-page":"511","article-title":"R\u00e9tention r\u00e9nale par p\u00e9riur\u00e9t\u00e9rite: lib\u00e9ration externe de l\u2019uret\u00e8re","volume":"9","author":"Albarran","year":"1905","journal-title":"Assoc Fr Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1016\/S0022-5347(17)69482-5","article-title":"Bilateral ureteral obstruction due to envelopment and compression by an inflammatory retroperitoneal process","volume":"59","author":"Ormond","year":"1948","journal-title":"J Urol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"256","DOI":"10.5114\/reum.2016.63667","article-title":"Retroperitoneal fibrosis - the state-of-the-art","volume":"54","author":"Runowska","year":"2016","journal-title":"Reumatologia"},{"key":"B4","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.autrev.2010.05.003","article-title":"The birthday of a new syndrome: IgG4-related diseases constitute a clinical entity","volume":"9","author":"Takahashi","year":"2010","journal-title":"Autoimmun Rev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s10165-011-0571-z","article-title":"Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011","volume":"22","author":"Umehara","year":"2012","journal-title":"Mod Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1111\/1756-185X.12863","article-title":"IgG4-related retroperitoneal fibrosis: a newly characterized disease","volume":"19","author":"Lian","year":"2016","journal-title":"Int J Rheum Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1038\/modpathol.2012.72","article-title":"Consensus statement on the pathology of IgG4-related disease","volume":"25","author":"Deshpande","year":"2012","journal-title":"Mod Pathol"},{"key":"B8","volume-title":"NORD compendium of rare diseases and disorders","year":"2008"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1016\/j.jvs.2008.11.072","article-title":"A new clinicopathological entity of IgG4- related inflammatory abdominal aortic aneurysm","volume":"49","author":"Kasashima","year":"2009","journal-title":"J Vasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"5","DOI":"10.7438\/1584-9341-12-1-2","article-title":"Long- term outcomes of open repair of inflammatory and atherosclerotic abdominal aortic aneurysms","volume":"12","author":"Elhelali","year":"2016","journal-title":"J Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1053\/ejvs.2001.1585","article-title":"Endovascular approach to abdominal aortic aneurysms limits the postoperative systemic immune response","volume":"23","author":"Sweeney","year":"2002","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1053\/ejvs.1999.0923","article-title":"Fifteen-year experience of transperitoneal management of inflammatory abdominal aortic aneurysms","volume":"18","author":"Sultan","year":"1999","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1681\/ASN.2015101110","article-title":"Idiopathic retroperitoneal fibrosis","volume":"27","author":"Vaglio","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1148\/rg.332125085","article-title":"Retroperitoneal fibrosis: role of imaging in diagnosis and follow-up","volume":"33","author":"Caiafa","year":"2013","journal-title":"Radiographics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S0140-6736(06)68035-5","article-title":"Retroperitoneal fibrosis","volume":"367","author":"Vaglio","year":"2006","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S0889-857X(05)70260-X","article-title":"Retroperitoneal fibrosis: a true connective tissue disease","volume":"22","author":"Gilkeson","year":"1996","journal-title":"Rheum Dis Clin North Am"},{"key":"B17","doi-asserted-by":"publisher","first-page":"321","DOI":"10.2214\/ajr.157.2.1853816","article-title":"Retroperitoneal fibrosis","volume":"157","author":"Amis","year":"1991","journal-title":"AJR Am J Roentgenol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0022-5347(17)56223-0","article-title":"Idiopathic retroperitoneal fibrosis","volume":"122","author":"Lepor","year":"1979","journal-title":"J Urol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"250","DOI":"10.5555\/uri:pii:0039606077902252","article-title":"The clinical significance of retroperitoneal fibrosis","volume":"81","author":"Koep","year":"1977","journal-title":"Surgery"},{"key":"B20","doi-asserted-by":"publisher","first-page":"535","DOI":"10.2214\/ajr.137.3.535","article-title":"CT In retroperitoneal fibrosis","volume":"137","author":"Brun","year":"1981","journal-title":"AJR Am J Roentgenol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/BOR.0b013e3283412f7c","article-title":"Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease","volume":"23","author":"Stone","year":"2011","journal-title":"Curr Opin Rheumatol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s13075-018-1567-2","article-title":"Failure of remission induction by glucocorticoids alone or in combination with immunosuppressive agents in IgG4-related disease: a prospective study of 215 patients","volume":"20","author":"Wang","year":"2018","journal-title":"Arthritis Res Ther"},{"key":"B23","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.juro.2007.03.057","article-title":"Combined prednisone and mycophenolate mofetil treatment for retroperitoneal fibrosis","volume":"178","author":"Scheel","year":"2007","journal-title":"J Urol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1452.e5","DOI":"10.1016\/j.avsg.2015.04.070","article-title":"Endovascular repair of a false aneurysm developing from IgG4-related periaortitis during corticosteroid therapy","volume":"29","author":"Ikeda","year":"2015","journal-title":"Ann Vasc Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.ejvs.2009.05.005","article-title":"A systematic review of open versus endovascular repair of inflammatory abdominal aortic aneurysms","volume":"38","author":"Paravastu","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"985","DOI":"10.3346\/jkms.2011.26.8.985","article-title":"Retroperitoneal fibrosis in 27 Korean patients: single center experience","volume":"26","author":"Ha","year":"2011","journal-title":"J Korean Med Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"289","DOI":"10.2478\/pjs-2014-0051","article-title":"Retroperitoneal fibrosis as a rare cause of lower limb claudication","volume":"86","author":"Hapka","year":"2014","journal-title":"Pol Przegl Chir"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1016\/j.jvs.2016.12.140","article-title":"Upregulated interleukins (IL-6, IL-10, and IL-13) in immunoglobulin G4-related aortic aneurysm patients","volume":"67","author":"Kasashima","year":"2018","journal-title":"J Vasc Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0227479","DOI":"10.1371\/journal.pone.0227479","article-title":"Clinical implications of elevated serum interleukin-6 in IgG4-related disease","volume":"15","author":"Tsukuda","year":"2020","journal-title":"PLoS One"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1688","DOI":"10.1002\/art.39132","article-title":"Second international symposium on IgG4-related disease. International consensus guidance statement on the management and treatment of IgG4-related disease","volume":"67","author":"Khosroshahi","year":"2015","journal-title":"Arthritis Rheumatol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.946675\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T04:23:54Z","timestamp":1658204634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.946675\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,15]]},"references-count":30,"alternative-id":["10.3389\/fsurg.2022.946675"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.946675","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,15]]},"article-number":"946675"}}