Physician-modified fenestrated thoracic endovascular aortic repair for a rapidly developing infectious distal aortic arch aneurysm after intravesical bacillus Calmette-Guérin therapy.

An 84-year-old man developed hemoptysis 3 weeks after receiving intravesical bacillus Calmette-Guérin therapy for bladder cancer. Computed tomography revealed a new saccular distal aortic arch aneurysm involving the origin of the left subclavian artery, with periaortic inflammation. Computed tomography performed 3 months earlier had shown no aneurysm. Urine polymerase chain reaction testing was positive for the Mycobacterium tuberculosis complex, supporting the diagnosis of a bacillus Calmette-Guérin-related infectious aortic aneurysm. Given the prohibitive surgical risk, emergency endovascular repair was performed using a physician-modified fenestrated endograft with branch revascularization in combination with antituberculous therapy. Hemoptysis resolved, and no recurrence was observed at 1-year follow-up.