Epithelioid angiosarcoma, a rare complication of endovascular aneurysm repair.

ANGIOSARCOMA, A RARE COMPLICATION OF ENDOVASCULAR ANEURSYM REPAIR Foguenne Maxime & Dasnoy Denis. We report the case of an 67-years old man presenting a epithelioid angiosarcoma developing from the left iliac artery occurring four years after the endovascular repair of a left primitive iliac aneurysm. 42 months after initial surgery, a left iliac artery angioplasty-stenting was performed for parietal thrombosis of the prosthesis, causing claudication. 1 months later, the CT demonstrated a size augmentation of the aneurysm, which was assumed to be an type-2 endoleaks ; this diagnosis was refuted by surgical arteriography. During the same procedure, a new left iliac artery angioplasty-stenting was performed for recurrence of parietal thrombosis. He presented 3 months later an abdominal and dorsal pain, constipation and weight loss. On biology, he suffered from an inflammatory syndrome without association with fever. The radiological findings showed both parietal thrombosis of the right iliac artery and growing enlargement of the initial aneurysm site without evidence of leaks. The MRI showed no arguments for a spondylodiscitis. PET-CT revealed 3 sites of hyperfixation including the endoprothesis-site ; there was no capture on the marked-WBC scintigraphy. Hemocultures were 3-times sterile, an trans-esophageal echocardiography was performed without signs of endocarditis. With all this information, the diagnosis of endovascular graft infection was retained, the Dacron-endovascular graft was totally removed and a new aorto bi-iliac prosthesis was implanted by laparotomy. The bacteriological analyses of the initial graft were sterile instead of the anatomo-pathological analysis which revealed an epithelioid angiosarcoma developing from the prothesis ; a taxol-based treatment was immediately started. Unfortunately, the patient’s general condition worsened very quickly with development of multiple lymphadenopathies in both inguinal regions. The patient was transferred for palliative care a few days later