Epithelioid Angiosarcoma after EVAR. A Case Report

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Diagnostic Imaging

Background:

• Endovascular aneurysm repair (EVAR) is a standard treatment for aneurysms, but complications can arise.
• Endoleaks are the most frequent complication, while graft infection diagnosis can be difficult.
• Epithelioid angiosarcoma is an uncommon malignancy that can occur post-EVAR.

Observation:

• A 64-year-old male presented with pain and aneurysm recurrence four years after EVAR.
• Imaging revealed aneurysm recurrence and abnormal tracer uptake, but no signs of graft infection.
• Histological analysis of the explanted endograft confirmed epithelioid angiosarcoma.

Findings:

• The patient developed epithelioid angiosarcoma following EVAR.
• Diagnostic imaging, including CT angiography and FDG-PET-CT, presented challenges in identifying the malignancy.
• Despite treatment, the patient's outcome was poor.

Implications:

• Consider aortic tumors in EVAR patients with morphological changes in the aortic wall or aneurysm sac.
• This case underscores the diagnostic challenges associated with rare post-EVAR malignancies.
• Early recognition and consideration of rare complications are crucial for patient management.