Malignant Aortic Tumors Following Open and Endovascular Implantation of Prosthetic Vascular Grafts

Objective: The aim of this study is to review the available literature on primary malignant aortic tumors following implantation of prosthetic vascular grafts. Methods: A comprehensive literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar using the following search queries: primary malignant tumors of the aorta; angiosarcoma of the aorta; aortic tumors vascular graft; angiosarcoma of the aorta Dacron graft; angiosarcoma of the aorta endovascular aortic repair; pseudoaneurysm or infection vascular graft; and pseudoaneurysm or infection endovascular aortic repair. In addition to the literature review, we report the case of a 59-year-old male who died of metastatic aortic angiosarcoma, following a staged replacement of the entire aorta using hybrid (combined open and endovascular) approaches. Results: Our search produced 176 articles on primary malignant aortic tumors for review. We identified 18 publications on primary malignant aortic tumors following implantation of prosthetic vascular grafts, which included a total of 20 patients: 10 cases after open surgical implantation and 10 after endovascular stent-grafting. Our review showed that 9 of 20 patients (45.0%) with aortic tumors presented with a pseudoaneurysm or suspected graft infection. However, the prevalence of primary aortic malignancy in association with pseudoaneurysm or graft infection was only reported in these 9 cases. Conclusions: Primary malignant aortic tumors are extremely uncommon, and are associated with very poor prognosis. The diagnosis should be considered in presence of a mass in association with a vascular prosthetic graft, especially if there is a pseudoaneurysm or periaortic inflammatory reaction. Further studies to search for the mechanisms involved in foreign body tumorigenesis in association with graft infection are still needed. Keywords: primary aortic tumors; epithelioid angiosarcoma; Dacron vascular graft; endovascular stent-grafting; pseudoaneurysm; infection after endovascular aortic repai