Long-Term Stabilization after Thoracic Endovascular Aortic Repair for a Behçet-Related Thoracic Aortic Aneurysm: A Case Report
- 1Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
Abstract
INTRODUCTION: Behçet disease is a relapsing systemic vasculitis that can rarely cause aortic aneurysms or pseudoaneurysms. Endovascular repair is increasingly used for Behçet-related aortic lesions, but the long-term interaction between aneurysm remodeling, endoleak, and systemic inflammatory activity remains clinically important.
CASE PRESENTATION: A 34-year-old man presented with persistent back pain due to an impending rupture of a newly developed saccular descending thoracic aortic aneurysm. Emergency thoracic endovascular aortic repair was performed before Behçet disease was definitively diagnosed. Postoperatively, persistent fever, elevated inflammatory markers, recurrent oral aphthous ulcers, and intestinal ulcerations led to the diagnosis of Behçet disease. The aneurysm initially regressed after corticosteroid therapy but rapidly re-expanded during steroid tapering, in parallel with fever, back pain, and increased C-reactive protein and erythrocyte sedimentation rate, despite no demonstrable type I or III endoleak. Additional endovascular reinforcement and intensified immunosuppressive therapy were performed. A type II endoleak from the left first lumbar artery was subsequently detected, but the aneurysm continued to regress under inflammatory control. More than 13 years after the initial repair, the treated aneurysm remains completely regressed.
CONCLUSIONS: This case suggests that sac enlargement after endovascular repair for a Behçet-related aortic aneurysm should be evaluated as a potentially multifactorial event, including occult endoleak, persistent sac pressurization, stent-graft-related mechanical factors, and systemic inflammatory activity. In this case, durable stabilization was observed following combined endovascular treatment and sustained immunosuppressive therapy.
Related
- A snare-assisted pull-up technique for side-branch component delivery during thoracic endovascular aortic repair for distal aortic arch aneurysm using Gore Thoracic Branch Endoprosthesis
- Hybrid approach with thoracic endovascular treatment and abdominal aortic replacement for acute type B aortic dissection complicated by ruptured abdominal aortic aneurysm
- Thoracic endovascular aortic repair-first hybrid repair without thoracotomy for type V thoracoabdominal aortic aneurysm
- Physician-modified fenestrated thoracic endovascular aortic repair for a rapidly developing infectious distal aortic arch aneurysm after intravesical bacillus Calmette-Guérin therapy.
- Integrated Analysis of Serotonin-Related Biomarkers in Thoracic Aortic Aneurysm Based on Machine Learning and Single-Cell Sequencing Data
BibTeX
@article{oue2026longterm,
title = {{Long-Term Stabilization after Thoracic Endovascular Aortic Repair for a Behçet-Related Thoracic Aortic Aneurysm: A Case Report}},
author = {Kensuke Oue and Moe Kinoshita and Shintaro Okuda and Nobuo Kondo},
journal = {Surgical Case Reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0577},
url = {https://doi.org/10.70352/scrj.cr.26-0577},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-Term Stabilization after Thoracic Endovascular Aortic Repair for a Behçet-Related Thoracic Aortic Aneurysm: A Case Report
AU - Kensuke Oue
AU - Moe Kinoshita
AU - Shintaro Okuda
AU - Nobuo Kondo
PY - 2026
DA - 2026/10/24
JO - Surgical Case Reports
DO - 10.70352/scrj.cr.26-0577
UR - https://doi.org/10.70352/scrj.cr.26-0577
AB - INTRODUCTION: Behçet disease is a relapsing systemic vasculitis that can rarely cause aortic aneurysms or pseudoaneurysms. Endovascular repair is increasingly used for Behçet-related aortic lesions, but the long-term interaction between aneurysm remodeling, endoleak, and systemic inflammatory activity remains clinically important. CASE PRESENTATION: A 34-year-old man presented with persistent back pain due to an impending rupture of a newly developed saccular descending thoracic aortic aneurysm. Emergency thoracic endovascular aortic repair was performed before Behçet disease was definitively diagnosed. Postoperatively, persistent fever, elevated inflammatory markers, recurrent oral aphthous ulcers, and intestinal ulcerations led to the diagnosis of Behçet disease. The aneurysm initially regressed after corticosteroid therapy but rapidly re-expanded during steroid tapering, in parallel with fever, back pain, and increased C-reactive protein and erythrocyte sedimentation rate, despite no demonstrable type I or III endoleak. Additional endovascular reinforcement and intensified immunosuppressive therapy were performed. A type II endoleak from the left first lumbar artery was subsequently detected, but the aneurysm continued to regress under inflammatory control. More than 13 years after the initial repair, the treated aneurysm remains completely regressed. CONCLUSIONS: This case suggests that sac enlargement after endovascular repair for a Behçet-related aortic aneurysm should be evaluated as a potentially multifactorial event, including occult endoleak, persistent sac pressurization, stent-graft-related mechanical factors, and systemic inflammatory activity. In this case, durable stabilization was observed following combined endovascular treatment and sustained immunosuppressive therapy.
SN - 2198-7793
ER -