RARE RUPTURE OF SMALL 4.3 CM ABDOMINAL AORTIC ANEURYSM: A CASE REPORT

Objectives: Abdominal aortic aneurysm (AAA) is a common medical condition with the most feared and often fatal complication of rupture. About 50% of patients with ruptured AAA die prior to hospitalization with an additional 30-50% mortality rate among those that do survive to hospital arrival. Aneurysm diameter has been documented as the largest risk factor for rupture with annual rupture risk for AAA under 5 cm being reported between 0.5-2%. The patient is a 75-year-old female with a past medical history of hypertension, hyperlipidemia, stroke, type II diabetes who reported to the hospital and was admitted for generalized fatigue. She was diagnosed with COVID pneumonia. The patient was managed with steroids and supportive therapy. Nine days into her hospitalization, the patient was clinically improving but developed acute onset abdominal pain. CT abdomen and pelvis obtained that revealed a ruptured 4.3 cm infrarenal AAA (Fig.1). Vascular surgery was consulted, and the patient was emergently taken to the operating room. Patient then underwent endovascular repair of her AAA with bifurcated aortoiliac stent graft. Patient tolerated the procedure well. She continued to recover from her COVID pneumonia and was discharged to skilled nursing facility post operative day 7.Rupture of AAA less than 5 cm is exceedingly rare, and currently only observation with serial imaging is recommended. However, in the setting of known asymptomatic AAA, rupture must remain in the differential diagnosis when abdominal or back pain develop. This case also demonstrates that in stable patients, ruptured AAA can be safely managed with an endovascular approach.

Methods:

Results:

Conclusion: