Abstract
Endovascular aneurysm repair (EVAR) has become widely adopted as the primary treatment modality for abdominal aortic aneurysm(AAA) in the elective settings. Recently, it has been reported that EVAR for ruptured AAA (rAAA) is associated with acceptable mortality rates. In EVAR for rAAA, the persistency of endoleak might be countinous intra-abdominal bleeding, and unfavorable for success treatment of rAAA. A 56-year-old man was referred to our hospital for suffering from left abdominal pain with shock vital status. On arrival, his blood pressure was not be measurable. After endotracheal intubation in the emergency room, contrast enhanced computed tomography (CT) was performed, which revealed ruptured AAA with huge retroperitoneal hematoma. Length of the proxymal neck was 20 mm and EVAR appeared feasible. We decided to repair the rAAA by EVAR emergently. After deploying the stentgrafts, type II endoleak (EL) was detected. No additional procedure was necessary after the surgery, because his circulatory status was stable without much blood transufusion. Postoperative CT demonstrated that the size of AAA was remarkably decreased, although the type II EL was still exist, and the retroperitoneal hematoma were vanished 6 months after the sugery. Furthermore, the type II EL was reduced 12 months after the surgery without enlarging the aneurysm size. We reported a case of rAAA successfully treated by emergent EVAR. Although the type II EL persisted after EVAR, the patient has overcome the critical preoperative condition and got the uneventful postoperative course without any additional intervention. It is important to keep attention to endoleak and deliberate the necessity of additional intervention for susessful EVAR for rAAA.
