Aneurysm formation at both ends of an endograft associated with maladaptive aortic changes after endovascular aortic repair in a healthy patient

We report a case in which saccular aneurysms formed at both ends of an endograft that exhibited maladaptive aortic changes after endovascular aortic repair in a patient without significant evidence of connective tissue disease. A 66-year old male underwent thoracic endovascular aortic repair (TEVAR) for a distal aortic arch aneurysm. A follow-up computed tomography (CT) scan performed at 6 months after the TEVAR detected a small saccular aneurysm at the distal edge of the endograft. At 10 months after the TEVAR, a new large aneurysm appeared at the proximal edge of the endograft. To prevent the latter aneurysm rupturing, total arch replacement with endograft fixation was performed. A CT scan obtained at 18 months after the TEVAR demonstrated that the aneurysm at the distal edge of the endograft had progressed and so we considered reintervention. Unfortunately, the patient died of intracranial haemorrhaging before the second procedure could be carried out. A histopathological examination of the aneurysm wall did not detect any significant background factors, such as connective tissue disease, inflammation or infection. The present case involved unexpected late complications, which might have been caused by changes in the form of the aorta after TEVAR.