Is it too late to treat me?

We present the case of a 76-year-old Caucasian man with a type 1 endoleak at the proximal edge of a thoracic stentgraft (Talent 38 mm × 114 mm) detected four years after endovascular treatment of a large symptomatic saccular aneurysm in the distal aortic arch. The patient refused any interventional treatment for the endoleak and remained on medical therapy with no evolving symptoms. Surveillance cardiac tomography (CT) showed the aneurysm continuing to expand, extending towards the chest wall and causing erosion of the ribs (Figure 1). After two years, the patient caught influenza with intense cough and suddenly noticed a pulsatile lump in his left chest wall. A new CT revealed the aneurysm expanding through the first left intercostal space, reaching the chest wall surface (Figure 2).