Stanford Type A Aortic Dissection During Adjuvant Capecitabine Chemotherapy for Colorectal Cancer.

backgroundCapecitabine, an oral prodrug of 5-fluorouracil, is widely used for gastrointestinal malignancies. While its coronary toxicity is well documented, large-vessel complications such as aortic dissection are rarely reported. CASE SUMMARY: We present a 65-year-old man with colorectal cancer who developed Stanford type A aortic dissection 3 days after initiating adjuvant capecitabine therapy. Imaging revealed extensive dissection from the ascending to the abdominal aorta. Emergency hemiarch replacement was successfully performed. DISCUSSION: The absence of prior cardiovascular disease, close temporal relationship, and known vasotoxicity of fluoropyrimidines suggest a likely association. Fluoropyrimidines may induce endothelial injury, vasospasm, and hypertension. A history of smoking in our patient may have contributed to vascular susceptibility. TAKE-HOME MESSAGES: Capecitabine, though well tolerated, may rarely cause life-threatening vascular complications such as aortic dissection. Clinicians should maintain a high index of suspicion for atypical vascular symptoms during therapy.