Temporizing endovascular repair of a ruptured mycotic abdominal aortic aneurysm

Ruptured mycotic abdominal aortic aneurysms (MAAAs) present a significant treatment challenge requiring emergency attention to control hemorrhage and hemodynamic compromise, surgical evacuation of the nidus of infection, and restoration of flow to compromised organs. We present a rare case of a MAAA with a contained rupture into the inferior vena cava in the setting of phlegmasia alba dolens of the bilateral lower extremities, sepsis, and significant hemodynamic compromise. A staged, hybrid approach with temporizing endovascular aneurysm repair, followed by extra-anatomic bypass and surgical resection of the MAAA, was performed.