Conservative management of ruptured abdominal aortic aneurysm secondary to type II endoleak

ObjectivesPrimary ruptured abdominal aortic aneurysm (rAAA) survival has been described in a few case reports; however, to our knowledge, there is no existing literature regarding rAAA survival secondary to isolated type II endoleak (T2EL). We aim to report a rare case of non-operative management for a T2EL-associated rAAA.MethodsAn 89-year-old man with a history of endovascular aneurysm repair (EVAR) and persistent T2EL presented with acute abdominal pain and hypotension. Computed topography angiography (CTA) confirmed rAAA with retroperitoneal haematoma. Given his advanced age, comorbidities, and initial preference against surgery, non-operative management was chosen.ResultsAfter resuscitation, the patient remained stable and was discharged 5 days later. A 4-week follow-up CTA showed haematoma resolution, despite mild enlargement of the aneurysm sac. He underwent elective embolization 2- and 4-month post-rupture. One year later, he represented with acute limb ischaemia. At the time, the treated aneurysm remained stable without endoleak.ConclusionThis case study sheds light on the possible different natural history between post-EVAR rAAA and primary rAAA, highlighting the possibility of non-operative management in select hemodynamically stable patients with rAAA after EVAR. While rare, rupture can occur from T2EL, underscoring the need for close surveillance among at risk population.