Discontinuation of Anticoagulation to Control Delayed Abdominal Aortic Aneurysm Rupture with Type 2 Endoleak Following Endovascular Repair: A Case Report

Abstract

Persistent type 2 endoleak (T2EL) after endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) has remained a significant clinical concern. Additionally, the effects of anticoagulation therapy on the incidence of T2EL and aneurysm sac enlargement after EVAR are unclear. We report a case of 77-year-old man with a state of shock due to ruptured AAA secondary to T2EL. He underwent EVAR at age 74 and was performed the embolization of the inferior mesenteric artery at age 76 because of a persistent T2EL and enlargement of AAA. He was admitted to our hospital due to sudden abdominal pain and was diagnosed with Fitzgerald grade 3 ruptured AAA. Because he was too frail to undergo surgical repair, we treated him with discontinuation of oral anticoagulant. A computed tomography revealed shrinkage of AAA and retroperitoneal hematoma. He attained remission after the treatment. This case suggests that the anticoagulant administration can be associated with an increased risk for persistent T2EL after EVAR. Therefore, a critical and balanced decision-making approach should be applied when treating AAA with EVAR in patients with anticoagulantion therapy.