Department of Digestive Surgery, Cliniques Universitaires St-Luc Université Catholique de Louvain, Brussels, Belgium.
Department of Surgery, Tulane University, School of Medicine, New Orleans, LA.
Ann Vasc Surg. 2022 Mar;80:395.e1-395.e6. doi: 10.1016/j.avsg.2021.10.053. Epub 2021 Nov 19.
Endovascular aneurysm repair (EVAR) has become a standard in the treatment of aneurysms. However, complications still occur. Endoleaks are the most common. Graft infection diagnosis might be challenging. Even uncommon, we describe a case of epithelioid angiosarcoma after EVAR.
A 64-year-old male came to our emergency department with left lumbar and left thigh flexion pain, increasing since a month. Four years before, he had been treated for a left common iliac artery aneurysm extending to the aortic bifurcation by EVAR with a bifurcated unibody aortic (AFX Endologix) endograft. The year before the admission, he was treated twice by percutaneous angioplasty for a symptomatic mural thrombus of the left endograft limb. On admission, CT angiogram showed a recurrence of the aneurysm associated with elevated lab inflammatory markers. FDG-PET-CT showed an abnormal tracer uptake in the endograft limbs and in the left inguinal area. White blood cell scintigraphy did not show any sign of endograft infection. CT angiogram performed 2 months later showed an additional increase of the infrarenal aortic and left common iliac aneurysms. We removed the endograft. Histological analysis showed an epithelioid angiosarcoma. Patient died a few weeks later during chemotherapy.
For patients that have undergone EVAR and have subsequently developed morphological changes of the aortic wall and aneurysmal sac, an aortic tumor should be considered. Imaging diagnosis was challenging for this rare case of epithelioid angiosarcoma.
血管内动脉瘤修复术（EVAR）已成为治疗动脉瘤的标准方法。然而，并发症仍时有发生。内漏是最常见的并发症。移植物感染的诊断可能具有挑战性。即使不常见，我们也描述了一例 EVAR 后上皮样血管肉瘤病例。
一名 64 岁男性因左腰和左大腿弯曲疼痛来到我们的急诊部，自一个月前开始疼痛加剧。四年前，他因左侧髂总动脉瘤延伸至主动脉分叉处接受了 EVAR 治疗，使用了分叉一体式主动脉（AFX Endologix）移植物。在入院前一年，他因左侧移植物肢体有症状的壁血栓接受了两次经皮血管成形术治疗。入院时，CT 血管造影显示动脉瘤复发，并伴有炎症标志物升高。FDG-PET-CT 显示移植物肢体和左腹股沟区域有异常示踪剂摄取。白细胞闪烁显像未显示移植物感染的任何迹象。两个月后的 CT 血管造影显示肾下主动脉和左侧髂总动脉瘤进一步增大。我们取出了移植物。组织学分析显示为上皮样血管肉瘤。患者在化疗后几周后死亡。
对于接受过 EVAR 治疗且随后出现主动脉壁和动脉瘤囊形态变化的患者，应考虑主动脉肿瘤。对于这种罕见的上皮样血管肉瘤病例，影像学诊断具有挑战性。
