TAA8. Aortic Epithelioid Angiosarcoma After Endovascular Treatment of Descending Aortic Ulcer

Abstract

Aortic epithelioid angiosarcoma is a rare disease. We report a case of epithelioid angiosarcoma of the abdominal aortic wall after endovascular treatment of descending aortic ulcer. A 55-year-old man, diagnosed with descending aortic ulcer through regular health examination, was implanted with a Gore Conformable TAG (W. L. Gore & Associates, Flagstaff, Ariz) at the suprarenal aorta, with celiac trunk covered. During 4-month follow-up, the patient had no complaints, and no graft migration was shown by computed tomography angiography (CTA) examination, yet superior mesenteric artery occlusion was observed. During 10-month follow-up, the patient presented with abdominal back pain, general fatigue, and fever. CTA examination showed abnormal density around the graft, which was assumed to be a graft infection with periaortic tissue compatible with an inflammatory reaction. After invalid treatment for infection, positron emission tomography-computed tomography was performed and showed avid fluorodeoxyglucose uptake at the descending aorta, retroperitoneum, right lung, pancreas, spleen, left kidney, mesenteric glands, and left whirl bone. Computed tomography-guided biopsy confirmed it as epithelioid angiosarcoma. On review of the CTA study, no sign of malignant tumor was found on the preoperative images; however, left renal metastases were seen on the 4-month postoperative images. There may have been an association between angiosarcoma and artificial graft observed in animal experiments or rare cases before. However, this is the first case of epithelioid angiosarcoma after Conformable TAG aortic endograft placement. In addition, the rapid onset of the tumor also confused us as to whether the cause of the descending aortic ulcer was arteriosclerosis or epithelioid angiosarcoma and whether the epithelioid angiosarcoma was primary or secondary to the artificial graft.