Unusual course of an abdominal aortic aneurysm in a patient treated with chemotherapy for gastric cancer

Abstract

Most aortic aneurysms have a degenerative genesis and show a slow expansion over years. Only a few patients with a rapid progression of mycotic or inflammatory aneurysm during some weeks or months have been reported. We report a patient with a rapidly growing symptomatic infrarenal aneurysm with a maximal diameter of 53 mm, which developed over a 5-month period from a normal aorta and did not feature typical signs of degenerative, inflammatory, or mycotic aneurysm. The aneurysm was successfully treated by endovascular repair. A complete shrinking of the aneurysm sac was demonstrated during a few weeks postoperatively. Because the patient received chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for metastatic gastric carcinoma 1 year before the aneurysm occurred, we postulate that chemotherapy induced a rapid expansion of the aorta in this patient.

Intratumoral pseudoaneurysm within a liver metastasis of gastric cancer: a case report

“…Two other cases involved acute enlargement of an abdominal aortic aneurysm following chemotherapy with gemcitabine, cisplatin, docetaxel, and 5-FU [21,22]. Some chemotherapy drugs have vascular toxicity and induce cell apoptosis leading to loss of integrity of the vascular wall [19][20][21][22][23]. In the present case, the ITPA was diagnosed during nivolumab administration as second-line chemotherapy following S-1 as adjuvant chemotherapy and RAM plus PTX as first-line chemotherapy.…”

“…Two cases of pseudoaneurysm developing after FOLFIRI (irinotecan, leucovorin, 5-fluorouracil: 5-FU) combined with bevacizmab and FOLFOX (oxaliplatin, leucovorin, 5-FU) have been reported [19,20]. Two other cases involved acute enlargement of an abdominal aortic aneurysm following chemotherapy with gemcitabine, cisplatin, docetaxel, and 5-FU [21,22]. Some chemotherapy drugs have vascular toxicity and induce cell apoptosis leading to loss of integrity of the vascular wall [19][20][21][22][23].…”

Rupture of Giant Superficial Femoral Artery Aneurysm in a Leukemic Patient Submitted to Chemotherapy

“…A recent study found that chemotherapy in the last 30 days is associated with a higher probability of treating patients affected by abdominal aortic aneurysms in emergency situations [5]. Other researchers have found a correlation between chemotherapy and rapid enlargement and rupture of aortic aneurysms [6–8]. Our patient has been treated for the last five months with cycles of azacitidine 75 mg/m 2 monthly; he complained of acute left thigh pain during the fifth cycle of treatment.…”

“…We can suppose that this chemotherapeutic agent may have played a role in the rapid expansion of the aneurysm until its rupture. A possible explanation has been suggested by Zanow et al [6]: Chemotherapy may induce a downregulation of the synthesis of collagen, elastin, and smooth muscular cells, and a stimulation of metalloproteases, and these combined effects could cause a rapid aneurysm enlargement. To the best of our knowledge, this is the first case of femoral artery aneurysm rupture likely to be associated with chemotherapy.…”

The effect of recent chemotherapy in aorto-iliac aneurysm repair

“…[15][16][17] Scarce evidence suggests a correlation between malignancy, Chx and aneurysmal degeneration. 6,18 In these few case reports, 6,18 growth rate substantially exceeded the expected 0.11 cm expansion per year for aneurysms 3-3.9 cm 19 or 0.13 ± 0.15 cm per year for ectatic aortas between 2.5 and 2.9 cm. 20 Vascular specialists often face the challenge of managing patients with malignancies and concomitant AAA that require repair and several treatment strategies have been suggested.…”