Endovascular repair of thoracic aortic aneurysm and intramural hematoma in giant cell arteritis

An 80-year-old woman with established giant cell arteritis presented at the authors' institution with a 6.5-cm false aneurysm of the descending thoracic aorta complicated by focal dissection and intramural hematoma after a 1-week history of acute-onset chest pain. The patient underwent uncomplicated endovascular aortic repair with a 32-mm X 15-cm TagExcluder stent-graft. After the procedure, the intramural hematoma resolved and the patient's corticosteroid and immunosuppressive therapy was repeatedly adjusted. However, the giant cell arteritis activity relapsed after 8 months with development of a similar 1.5-cm false aneurysm below the thoracic stent-graft, complicated by focal intramural hematoma. Repeat uncomplicated thoracic stent-graft implantation was performed and CT follow-up displayed resorption of the intramural hematomas with no evidence of endoleak or any new aortic pathology. This report discusses the difficult management of patients with relapsing active aortic giant cell arteritis and the potential role for endovascular thoracic aortic repair.