Primary angiosarcoma of aorta: A systematic review

Abstract

Purpose: To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta. Material and Methods: A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan–Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314. Results: 82 studies with n = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7–1560 days vs. 180 (IQR, 1–5730 days)], respectively. The overall median survival was 210 days (IQR, 1–5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival ( p < 0.03) irrespective of other attributes. Conclusion: The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.

Primary angiosarcoma arising in the sinus of Valsalva: A case report

“…Primary aortic neoplasms are uncommon [ [1] , [2] , [3] ], with the abdominal aorta as the predominant location, accounting for 40 % of the cases [ 5 ]. In this case, the diagnosis of an enlarged sinus of Valsalva aneurysm was confirmed by postsurgical pathological examination.…”

Angiosarcoma after endovascular aneurysm repair: case report and literature review

“…The prognosis of angiosarcoma is poor. In the recently published systematic review of Kordzadeh et al 123 cases with primary angiosarcoma were investigated with overall median survival of 210 days or 7 months [2]. Radical surgical resection with negative margins (R0) offers the best prognosis for localized non-metastatic angiosarcoma.…”

“…Adjuvant chemotherapy with doxorubicin-containing agents demonstrated a significantly lower disease relapse and resulted in a trend for longer survival. However, survival rates of only 4% after 10 years were noted [1][2][3]. We report two cases of patients who previously underwent an endovascular aneurysm repair (EVAR), and were diagnosed with an epithelioid angiosarcoma.…”