Abstract
RATIONALE: Acute thrombosis of an abdominal aortic aneurysm (ATAAA) is a rare but catastrophic complication of abdominal aortic aneurysm. For inherently high-risk ATAAA, a more invasive open surgical approach is associated with increased mortality. PATIENT CONCERNS: A 68-year-old male presented with sudden-onset severe back and lower limb pain persisting for over 9 hours. Physical examination revealed a pulsatile abdominal mass and bilateral lower limb ischemia. DIAGNOSES: Computed tomography angiography revealed a 4.5 cm infrarenal abdominal aortic aneurysm with acute thrombosis extending into both common iliac arteries, confirming the diagnosis of ATAAA. INTERVENTIONS: The proximal neck anatomy of the aneurysm was suitable for endovascular aneurysm repair (EVAR); accordingly, balloon thrombectomy followed by EVAR was performed. OUTCOMES: Complete revascularization was achieved. The patient was discharged on postoperative day 4 and remained asymptomatic at the 2-year follow-up. LESSONS: Only 5 cases of ATAAA treated with an endovascular approach have been reported. Although further validation is needed, EVAR shows promise as a safe and effective treatment for selected cases, potentially reducing the high mortality rate associated with this condition.