Largest Documented Peri-Aortic Hematoma Following the Bentall Procedure: A Case Report and Review of Surveillance Strategies.

Anastomotic graft leaks following thoracic aortic repair are rare but potentially life-threatening complications that may present with subtle symptoms, leading to delayed diagnosis. We present the case of a 74-year-old male who developed progressive dyspnea eight months after undergoing a Bentall procedure for an ascending aortic aneurysm. Imaging revealed a massive 13.2 × 11.2 × 11.5 cm contained peri-aortic hematoma, causing significant mass effect on nearby structures, which was successfully surgically repaired. This case represents the largest reported peri-aortic hematoma following Bentall surgery and highlights the challenges in detecting and managing late complications of open thoracic aortic repair, given the lack of standardized surveillance protocols for anastomotic open graft leaks.