Case Report: Brucella-associated complications following thoracic endovascular aortic repair: a case series of three patients

Background Brucellosis is a rare but potentially fatal cause of vascular graft infection. Evidence regarding Brucella-associated complications after thoracic endovascular aortic repair (TEVAR) remains limited. Case presentation: We report three elderly male patients who developed severe aortic complications following TEVAR, including pseudoaneurysm formation and aorto-esophageal fistula. All patients had a history of epidemiological exposure to Brucella and were diagnosed with active infection through serological testing (Rose Bengal test, serum agglutination test, Brucella IgG and IgM antibodies). Endovascular re-intervention combined with targeted anti-brucellosis therapy was performed in all cases. Results One patient achieved sustained clinical remission after repeat endovascular repair and prolonged antimicrobial therapy. Two patients developed catastrophic infectious complications, including mediastinal abscess and aorto-esophageal fistula, resulting in death despite aggressive management. Conclusions Brucella infection should be considered in patients presenting with unexplained symptoms after TEVAR, especially in endemic regions. Endovascular repair plays a critical role in acute stabilization; however, long-term outcomes remain highly dependent on effective infection control.