Late post-endovascular abdominal aortic repair rupture due solely to type II endoleak without other types of endoleak

Rupture of abdominal aortic aneurysm (AAA) due to an isolated type II endoleak (TIIEL) is rarely reported, accounting for less than 1% of all TIIELs; typically, rupture associated with TIIEL is accompanied by type I or type III endoleaks. We report a case of ruptured AAA secondary to TIIEL without any other types of endoleaks, occurring late after endovascular abdominal aortic repair (EVAR). A 77-year-old man with a history of EVAR 11 years earlier presented with abdominal pain. Computed tomography revealed a ruptured AAA, likely due to TIIEL from the lumbar artery. He was on warfarin for atrial fibrillation, and his preoperative PT-INR was 6.05. After administering lyophilized human prothrombin complex concentrate, lumbar artery ligation and aneurysmorrhaphy were performed. Intraoperatively, there was pulsatile bleeding from the lumbar artery, which was sutured closed. No other types of endoleaks were observed. The postoperative course was uneventful, and the patient was discharged home.