• Justin M Cappuzzo, Kathleen E Knudson, Shawn Sarin, Joseph Babrowicz, Abraham Cherrick, and Jonathan H Sherman.
• School of Medicine and Health Sciences, the George Washington University, Washington, District of Columbia, USA.
• World Neurosurg. 2018 Feb 1; 110: 232-239.

BackgroundAortic pseudoaneurysms are a rare cause of chronic back pain, usually resulting from compression of the adjacent neurovasculature. It is uncommon for patients with pseudoaneurysms of the abdominal aorta to present in a delayed fashion after initial traumatic injury.Case DescriptionWe describe an unusual case of delayed pseudoaneurysm formation with subsequent erosion into the adjacent L1 vertebral body. This pseudoaneurysm was secondary to a gunshot wound with retained ballistic fragment that had occurred 27 years previously. Herein, we discuss the patient's presenting symptoms, imaging, and overall treatment. In this particular case, we used a combined surgical and endovascular (hybrid) approach after the patient experienced recurrent low back pain, weeks after a primary endovascular treatment was performed. We additionally review the current literature on the management of aortic pseudoaneurysms causing vertebral body erosion and back pain.ConclusionsIn our patient, a combined surgical and endovascular (hybrid) approach led to the complete resolution of his back pain symptoms and to complete exclusion of the pseudoaneurysm on follow-up imaging. Endovascular management of aortic pseudoaneurysms may be a reasonable alternative to open surgery in high-risk patients; however, this approach may result in a higher recurrence of pseudoaneurysm and initial presenting symptoms. Further investigation is needed to elucidate the efficacy of endovascular treatment of these lesions.Copyright © 2017 Elsevier Inc. All rights reserved.

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