Abdominal aortic aneurysm and human immunodeficiency virus infection, a new indication for endovascular aneurysm repair?

Endovascular aneurysm repair (EVAR) is indicated in high-risk patients for conventional surgery, with anatomic conditions for endoprosthesis implantation. Low morbidity, mortality and physiological aggressiveness have been expanding the indications for its use. Still, EVAR is questionable in younger patients, with a low surgical risk and a prolonged life expectancy. Abdominal aortic aneurysms (AAA) are rare in human immunodeficiency virus (HIV) infected patients in western countries and have singular characteristics: an unknown etiology, multiple arterial involvement, poor open surgery results and risk of infection transmission to surgeons. For these reasons EVAR opened new therapeutic perspectives in this group of patients. We present our experience with two HIV patients in whom an AAA was diagnosed, one with a 10 cm diameter treated by EVAR, excluded with an aorto-uni-iliac endoprosthesis, other followed regularly, describing their features and therapeutic results. The reported cases allow us to speculate on the importance of anti-retroviral and endovascular treatments reducing the inflammatory process on the arterial wall, with a consequent delay in aneurysm growth and even its regression, which reinforces the possible relevance of EVAR as a first line treatment for this particular pathology.