# Endovascular repair with a physician-modified fenestrated endograft to treat abdominal aortic pseudoaneurysm with Behcet’s disease: a case report

## TL;DR

A rare case of aortic pseudoaneurysm in a patient with Behcet’s disease was successfully treated using a modified endovascular graft, avoiding open surgery.

## Contribution

A physician-modified fenestrated endograft was used to treat a paravisceral aortic pseudoaneurysm in a Behcet’s disease patient, preserving visceral arteries.

## Key findings

- Endovascular repair with a modified fenestrated endograft successfully excluded the pseudoaneurysm.
- The patient remained asymptomatic with no recurrence at an 18-month follow-up.
- Preservation of visceral arteries and prevention of recurrence were achieved without open surgery.

## Abstract

Aortic involvement in patients with Behcet’s disease (BD) is rare, but it is one of the most severe manifestations. Open surgical repair of aortic aneurysm is challenging considering the high risk of postoperative recurrent anastomotic pseudoaneurysms and is associated with a much higher mortality rate. Recently, endovascular treatment has proven to be a feasible, less invasive alternative to surgery for these patients.

We report a total endovascular repair of a paravisceral abdominal aortic pseudoaneurysm in a 25-year-old male patient with BD. The pseudoaneurysm was successfully excluded, and the blood supply of visceral arteries was preserved with a physician-modified three-fenestration endograft under 3D image fusion guidance. Immunosuppressive therapy was continued for 1 year postoperatively. At 18 months, the patient was asymptomatic without abdominal pain. Computed tomography angiography demonstrated the absence of pseudoaneurysm recurrence, good patency of visceral vessels.

Endovascular repair using physician-modified fenestrated endografts is a relatively safe and effective approach for treating paravisceral aortic pseudoaneurysm in BD patients. This technique enables the preservation of the visceral arteries and prevents aneurysm recurrence at the proximal and distal landing zones, which are common complications of open surgical repair in these patients. Furthermore, we emphasize the importance of adequate immunosuppressive therapy before and after surgical repair in BD patients, which is a major risk factor for recurrence and poor prognosis.