Endovascular Treatment of an Infrarenal Aortic Epithelioid Angiosarcoma Causing Critical Limb Ischemia in an 80-year-old Patient: A Case Report

Aortic angiosarcomas (AAS) occur in approximately one case per million people annually and are often difficult to diagnose due to their nonspecific clinical and radiological symptoms. An 80-year-old female presented with the absence of pulses of both lower limbs and feet tissue loss. A contrast-enhanced computed tomography (CT) scan showed the occlusion of the infrarenal abdominal aorta extending to the aortic bifurcation, involving both common and external iliac arteries up to the superficial femoral artery bilaterally. A Fogarty embolectomy of both side femoral axes was performed followed by a covered endovascular reconstruction of the aortic bifurcation (CERAB) with a covered stent graft and two covered iliac stents placed in a kissing stent configuration. Histological examination of the Fogarty embolectomy samples revealed an aortic localization of epithelioid angiosarcoma. Healing of feet trophic lesions was observed 2 months after surgery, regardless of physical and rehabilitation team intervention progressive cachexia and physical deterioration led the patient to death 5 months postoperatively. Due to their nonspecific clinical presentation, AAS are typically late diagnosed with poor prognosis despite treatment. Endovascular treatment was chosen as the only feasible option, given the high risk of limb loss and poor general health conditions. Moreover, it led to significant improvement in patient’s quality of life with no postoperative complications. Endovascular treatment associated with a physical and rehabilitation program may be advised as a less invasive alternative, for palliative or emergent clinical presentation in order to avoid short-term complications with poor impact on survival and quality of life.