A Case of Rapid Enlargement and Ruptured Abdominal Aortic Aneurysm (rAAA) in a Patient Treated with Chemotherapy Using Bevacizumab (BV)

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 77; no. 2; pp. 307 - 311
• Main Authors: YUKAWA, Takafumi, IHARA, Tsutomu, YAMAGUCHI, Ryuzou
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2016
• Subjects: abdominal aortic aneurysm; bevacizumab; EVAR
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.77.307

We report a case of enlarged and ruptured abdominal aortic aneurysm (rAAA) in a patient who was treated with chemotherapy using bevacizumab (BV). A 70-year-old man presented to our hospital with severe abdominal pain for the duration of chemotherapy (using BV for recurrence of rectal carcinoma). The pulsatile mass was palpable in the abdomen. He was alert and his blood pressure was 199/116 mmHg. Enhanced computed tomography (CT) revealed fusiform abdominal aortic aneurysm with a diameter of 48 mm and post-peritoneal hematoma. The diameter of the aneurysm was 43 mm, 6 month previously. We diagnosed rAAA, and considering the adverse effect of BV, selected endovascular aneurysm repair (EVAR) for treatment. Emergency aortography was performed, and no extravasation was found. We selected the Gore Excluder endoprosthesis and completed the operation with no endoleak. Enhanced CT revealed no endoleak 2 days after EVAR and the patient was discharged on postoperative day 4. The patient was in good condition, and chemotherapy was resumed one month after EVAR. It was possible that administration of BV was associated with the rupture. Therefore, in this case, we selected the precise method of treatment considering the adverse effect of BV.