Recurrent vascular complications in Behçet’s disease: a case report of multiple endovascular interventions

Behçet’s disease (BD) is a systemic vasculitis characterized by mucocutaneous lesions and multisystem involvement, including vascular complications. Arterial involvement, though less common, can lead to severe outcomes such as aneurysm formation and thrombosis. Our case is unique, not only involving a recurrence and rupture of a pseudoaneurysm after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm(AAA) in a patient with BD, but also including post-operative iliac artery stenosis, as well as restenosis and occlusion of the iliac artery stent. Since no similar case have been reported on public platforms to date, we aim to reiterate the importance of close monitoring of patients with BD through a review. We report a 27-year-old male with BD who developed recurrent vascular complications over a 15-year period, requiring four endovascular interventions. The patient initially presented with recurrent oral ulcers and subsequently developed deep vein thrombosis and an abdominal aortic pseudoaneurysm. He underwent EVAR, followed by repeated episodes of pseudoaneurysm recurrence, iliac artery stenosis, in-stent restenosis, and eventual stent occlusion. Management included long-term immunosuppressive therapy combined with multiple endovascular procedures. This case highlights the aggressive and recurrent nature of arterial involvement in BD, even after technically successful endovascular repair. It emphasizes the necessity of strict disease control with immunosuppressive therapy and close, long-term vascular surveillance in patients with BD who undergo endovascular interventions. Multidisciplinary management is essential to reduce the risk of restenosis, occlusion, and aneurysm recurrence.