Uemura Naoki, Saitoh Hirofumi, Shiotsuka Junji, Uchino Shigehiko, Katayama Shinshu
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, JPN.
Cureus. 2025 Jul 12;17(7):e87776. doi: 10.7759/cureus.87776. eCollection 2025 Jul.
Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), is used in combination with chemotherapy for various malignancies, including metastatic colorectal cancer. While effective, bevacizumab can inhibit normal blood vessel growth, leading to cardiovascular side effects not typically associated with conventional chemotherapy. We report a rare case, from an international perspective, of a 73-year-old man with a history of gastric cancer and newly diagnosed metastatic colorectal cancer complicated by a pre-existing abdominal aortic aneurysm (AAA) measuring 52 mm. The aneurysm was initially managed conservatively, as the multidisciplinary team (MDT) and the patient agreed to prioritize chemotherapy despite the known rupture risk, given his wish to avoid delaying treatment for his cancer. After the diagnosis of colorectal cancer during chemotherapy, bevacizumab was added to his regimen. He developed a rupture of the AAA two days after the fourth dose. Emergent open surgical repair was successfully performed without wound healing complications. This case highlights the potential risk of large-vessel complications associated with bevacizumab, especially in patients with known vascular anomalies. Careful imaging assessment and monitoring are imperative when considering bevacizumab for patients at risk of aortic rupture. In selected cases, prophylactic measures such as preemptive aneurysm repair should be contemplated to optimize safety.
贝伐单抗是一种抗血管内皮生长因子（VEGF）的人源化单克隆抗体，与化疗联合用于治疗各种恶性肿瘤，包括转移性结直肠癌。虽然贝伐单抗有效，但它会抑制正常血管生长，导致一些通常与传统化疗无关的心血管副作用。我们从国际视角报告了一例罕见病例，一名73岁男性，有胃癌病史，新诊断为转移性结直肠癌，并发一个已存在的直径52毫米的腹主动脉瘤（AAA）。该动脉瘤最初采取保守治疗，因为多学科团队（MDT）和患者同意，尽管已知存在破裂风险，但鉴于患者希望避免延误癌症治疗，还是优先进行化疗。在化疗期间诊断出结直肠癌后，其治疗方案中加入了贝伐单抗。在第四次给药两天后，他的腹主动脉瘤破裂。紧急进行了开放性手术修复，手术成功，且未出现伤口愈合并发症。该病例突出了与贝伐单抗相关的大血管并发症的潜在风险，尤其是在已知有血管异常的患者中。对于有主动脉破裂风险的患者，在考虑使用贝伐单抗时，必须进行仔细的影像学评估和监测。在某些选定的病例中，应考虑采取如预防性动脉瘤修复等预防措施，以优化安全性。
