Re-rupture of Abdominal Aortic Aneurysm Associated with a Type II Endoleak after Prior Endovascular Repair

Abstract

A 69-year-old man was referred to our hospital because of sudden onset of abdominal pain. Computed tomography (CT) showed a ruptured abdominal aortic aneurysm (AAA), and an emergency endovascular abdominal aortic aneurysm repair (EVAR) was performed under local anesthesia. Postoperative CT showed Type II endoleaks from the lumbar arteries and the inferior mesenteric artery (IMA). Because no pulsation was detected in the aneurysm and he appeared to be in a stable general condition, he was followed up on an outpatient basis. CT obtained 6 months post EVAR showed a mass projecting into the retroperitoneum and an atheroma in the AAA, and he was diagnosed with a contained rupture of the AAA. Angiography showed Type II endoleaks from the lumbar arteries; however, no Type I endoleak was observed. We chose an open surgical repair procedure for definitive treatment of the Type II endoleak. Intraoperatively, the walls of the AAA were exfoliated from the right and left and lumbar arteries and the IMA was ligated from outside the aneurysm. A rupture was confirmed in the right posterior wall of the AAA. The atheroma and hematoma were removed from the AAA, and we confirmed no retrograde blood flow into the aneurysm sac. We successfully performed open surgical repair for re-rupture of an AAA associated with Type II endoleak after previous EVAR.