Rupture of an abdominal aortic aneurysm (AAA) following endovascular aortic repair (EVAR) typically requires reintervention. However, EVAR patients are often elderly and frail, increasing surgical risks. Case 1 involved an 85-year-old man (Clinical Frailty Scale [CFS] score: 6) who underwent EVAR six years earlier without endoleak. He presented with poor oral intake, and contrast-enhanced CT showed a small type II endoleak and Fitzgerald stage II AAA rupture near the left psoas muscle. Symptoms resolved quickly with conservative management. Three months later, the hematoma expanded to Fitzgerald stage III, with a chronic contained rupture into the left psoas muscle. Conservative management was again selected, and he has remained asymptomatic for three years. Case 2 involved an 81-year-old man (CFS score: 5) who underwent EVAR two years earlier without endoleak. He developed abdominal pain after a fall. Contrast-enhanced CT revealed Fitzgerald stage II AAA rupture and retroperitoneal hematoma without contrast extravasation. His symptoms resolved quickly, and he was discharged after conservative management. He has remained asymptomatic for four years. Although reintervention is standard for suspected AAA rupture post-EVAR, conservative management may be appropriate in selected cases, considering clinical findings and surgical tolerance.

The patient is a 76-year-old man who had undergone transurethral resection of bladder tumor and intravesical BCG (Bacillus Calmette-Guérin) therapy for bladder cancer. 17 months after that, CT scan incidentally revealed an irregular saccular infrarenal aortic aneurysm, which showed a rapid dilatation and EVAR was performed emergently. Based on the clinical course, it was presumed to be a BCG-induced aneurysm, but the patient had been free of any signs of infection. 4 months later, the patient developed persistent black stools and was diagnosed as having an aorto-duodenal fistula. He underwent prosthetic vessel replacement, partial duodenal resection and omental implantation. Although he had been treated with antibiotics without signs of infection, on the 84th postoperative day, he came to our emergency room with a complaint of anorexia and general malaise. CT scan revealed a large pseudoaneurysm associated with a rupture of the proximal anastomosis of the prosthetic vessel, but he did not wish to undergo invasive treatment and died soon after admission.

This case was a 68-year-old woman. She was aware of a mass on her right forearm for about 3 years, which gradually enlarged. A venous aneurysm (VA) with a maximum short diameter of 13 mm and a length of 60 mm was found in the radial cutaneous vein of the right forearm on ultrasonography and contrast-enhanced CT. She was then followed up, but after 2 months, pain due to thrombosis appeared, and after ultrasonography, the varicose vein was excised. Venous vascular aneurysms of the upper extremities are relatively rare and the cause is often unknown. The radial cutaneous vein is a site that is easily punctured for blood sampling, etc. Frequent punctures were thought to be one of the causes.