Key result
Systemic chemotherapy fails to prevent 7-month mortality from post-EVAR aortic spindle cell sarcoma.
Case Report (n=1)
Aortic sarcoma following EVAR is rare and may mimic infection or inflammatory complications, highlighting the need to consider malignant etiologies when transplant recipients with prior EVAR present with atypical aneurysm enlargement.
Consider malignancy in atypical post-EVAR aneurysm enlargement among transplant recipients; this case leaves open any causal role for EVAR or immunosuppression.
A kidney transplant recipient developed spindle cell sarcoma within an abdominal aortic aneurysm following prior endovascular aneurysm repair (EVAR). The patient had undergone EVAR for abdominal aortic aneurysm before successful living‐donor kidney transplantation and maintained stable graft function under immunosuppressive therapy. Two years after transplantation, he presented with back pain, elevated inflammatory marker, and aneurysm enlargement, initially suspected as an infected aneurysm. Despite antibiotic therapy, the lesion progressed. Positron emission tomography demonstrated increased fluorodeoxyglucose uptake, and computed tomography‐guided biopsy revealed undifferentiated spindle cell sarcoma with unclear lineage differentiation. Surgical resection was not feasible, and systemic chemotherapy was initiated; however, disease progression continued, and the patient died 7 months after admission. Aortic sarcoma following EVAR is rare and may mimic infection or inflammatory complications. Clinicians should consider malignant etiologies when transplant recipients with prior EVAR present with atypical aneurysm enlargement or persistent inflammatory findings, and early tissue diagnosis may be necessary.
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Kakeshita et al. (2026) conducted a case report in Spindle cell sarcoma of the abdominal aorta (n=1). Endovascular aneurysm repair (EVAR) was evaluated on Disease progression and mortality. A kidney transplant recipient with prior EVAR developed an undifferentiated spindle cell sarcoma of the abdominal aorta that progressed despite systemic chemotherapy, resulting in death at 7 months.
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