Impending rupture in the apparent healing phase after chimney EVAR for a BCG-related paravisceral infective aortic aneurysm

Abstract We describe a 75-year-old man with a paravisceral infective native aortic aneurysm secondary to intravesical Bacillus Calmette–Guérin (BCG) therapy for bladder cancer. He initially underwent chimney endovascular aneurysm repair without antituberculosis therapy. After referral to our hospital, Mycobacterium bovis was isolated from retroperitoneal abscess and antituberculosis multidrug therapy was started. Despite clinical improvement and radiological appearance of abscess liquefaction, computed tomography at 3 months demonstrated endograft migration and rapid enlargement of the aneurysm. Emergent total radical excision of infected paravisceral aorta, all endografts and retroperitoneal abscess was performed with extra-anatomical revascularization, with no evidence of reinfection to date.