Case Report: Successful Management of a Ruptured Abdominal Aortic Aneurysm With Concurrent Acute Myocardial Infarction in an 84‐Year‐Old Male

ABSTRACT

Rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event with mortality rates historically approaching 80%, often compounded by significant coronary artery disease. We present the challenging case of an 84‐year‐old man who presented with a contained AAA rupture and a synchronous acute myocardial infarction. Given his hemodynamically stable but precarious state, our team prioritized immediate percutaneous coronary intervention with drug‐eluting stents, which mandated dual antiplatelet therapy (DAPT). An ensuing attempt at endovascular repair (EVAR) failed because of extensive iliac calcification and a femoral artery injury that occurred during access. Consequently, open surgical repair was undertaken on hospital Day 5 despite ongoing DAPT—a high‐risk maneuver that proceeded without major bleeding complications. This exceptional outcome underscores that, in select patients with a contained rupture, a strategy of prioritized coronary revascularization followed by open repair while on DAPT can be successful, highlighting the vital importance of adaptable, multidisciplinary decision‐making. At 2.5 years, the patient remains alive and functionally independent, confirming the durability of this approach.