Emergent Open Conversion for Ruptured Arch Aneurysm After Thoracic Endovascular Repair in Chronic Actinic Dermatitis

BACKGROUND: Chronic actinic dermatitis is a rare photosensitive disorder that often requires long-term systemic corticosteroid therapy, which may contribute to aortic wall fragility. CASE SUMMARY: A 74-year-old man with chronic actinic dermatitis who has been receiving oral corticosteroid therapy for 30 years underwent thoracic endovascular aortic repair (TEVAR) for a saccular aortic arch aneurysm. One year later, he developed rapid aneurysmal expansion and rupture due to a type 1a endoleak caused by stent-graft migration. Emergent total arch replacement with a frozen elephant trunk was successfully performed under strict perioperative and postoperative light-shielding management, without infectious complications or exacerbation of dermatologic symptoms. DISCUSSION: Long-term corticosteroid therapy may contribute to aortic wall fragility, progressive proximal aortic dilatation, and sealing failure after TEVAR. This case also demonstrates that meticulous perioperative and postoperative light-shielding strategies can enable safe open cardiovascular surgery in patients with severe photosensitive disorders. TAKE-HOME MESSAGE: Careful surveillance after TEVAR and individualized surgical strategies, including timely open conversion when further endovascular treatment is not feasible, are essential for managing complex aortic disease in patients with photosensitive disorders.