Residual aneurysmal angiosarcoma diagnosed after pulmonary multiple nodules appeared post additional embolization for Type 2 Endoleak

We report the case of a 66-year-old man diagnosed with multiple pulmonary angiosarcomas 4 years post-endovascular aneurysm repair (EVAR). The patient was healthy with a good postoperative course, besides requiring additional coil embolization for a lumbar artery type 2 endoleak (T2EL) 3 years post-EVAR. He presented to the emergency department with sudden respiratory distress and severe anemia. Computed tomography (CT) revealed multiple pulmonary nodules bilaterally. Thoracoscopic pulmonary nodule resection and pathological examination revealed angiosarcoma. The condition progressed rapidly, and the patient died 17 days post-admission. Postmortem pathological analysis demonstrated angiosarcomas of the primary residual aneurysmal mass post-EVAR, inferior vena cava invasion adjacent to the mass, and multiple pulmonary metastases bilaterally. Findings suggestive of angiosarcoma were found 6 months post-T2EL coil embolization when reviewing the annual positron emission tomography CT. We suspect that irradiation during T2EL treatment post-EVAR may have triggered angiosarcoma development. To the best of our knowledge, this is the first study to evaluate the relationship between T2EL and angiosarcoma.