Abstract
Angiosarcoma arising in the aortic wall after endovascular aneurysm repair (EVAR) is an exceptionally rare but devastating complication. We report a case of a 76-year-old man who developed progressive systemic symptoms and persistent imaging abnormalities years after EVAR. Despite extensive workup and empirical treatment for graft infection and aortitis, diagnosis was delayed until biopsy revealed angiosarcoma. The clinical course was rapidly progressive and ultimately led to death. Atypical symptoms after EVAR should raise suspicions of malignancy. Early tissue diagnosis is essential for the timely recognition of this aggressive and frequently misdiagnosed entity, which often carries a poor prognosis.