Late Aortic Rupture Due to Stent Margin Pseudoaneurysm Formation Complicating Endovascular Stent Graft Repair of a Thoracic Aortic Mycotic Aneurysm

Acute rupture of a thoracic mycotic aneurysm is a surgical emergency that requires urgent treatment to prevent further bleeding. The results of surgical repair are limited by high mortality and paraplegia rates. Endovascular repair with stent graft deployment has been reported as an alternative to high-risk surgery. We present the case of a patient with a ruptured mycotic aneurysm of the thoracic aorta complicated by an aorto-oesophageal fistula. Endovascular stent graft deployment was successful at controlling bleeding. Oesophagectomy was required for a persistent leak from the oesophagus. The patient remained stable for 13 months after the index procedure and died from aortic rupture. This was related to the development of a pseudoaneurysm of the aortic arch immediately proximal to the stent margin. This complication may result from mechanical factors related to the presence of a stent graft.

Keywords: Stent graft, Endovascular repair, Mycotic aortic aneurysm, Aorto-oesophageal fistula, Late rupture