Late aneurysm sac enlargement due to type II endoleak-like bleeding following open abdominal aortic aneurysm repair

Type II endoleak-like bleeding after open abdominal aortic aneurysm (AAA) repair is extremely rare. We report a case of aneurysm sac re-expansion in a 71-year-old man 13 years after open AAA repair. The wrapped aneurysm expanded from 55 mm to 70 mm, with a computed tomography scan showing contrast medium inflow from the aneurysm wall. Reoperation revealed diffuse bleeding without discrete branch vessel hemorrhage. This case demonstrates that type II endoleak-like bleeding can occur as a late complication after open AAA repair, even without bleeding from the branch vessels, highlighting the importance of long-term surveillance.