title: Symptomatic aneurysm rupture without bleeding secondary to endotension 4 years after endovascular repair of an abdominal aortic aneurysm.
abstract: OBJECTIVE
  To demonstrate the absence of bleeding from a ruptured abdominal aortic aneurysm (AAA) without evidence of endoleak following endovascular aneurysm repair (EVAR).
  
  
  METHODS
  A 72-year-old woman developed aneurysm enlargement 4 years after EVAR of an infrarenal AAA. During surgical exploration for abdominal pain and presumed aneurysm rupture, the ruptured aneurysm sac was found to be filled with gelatinous material without evidence of thrombus or active bleeding.
  
  
  CONCLUSIONS
  This case provides insight into the natural history of endotension and indicates that conservative management even in the face of an expanding aneurysm is a valid management option for selected patients.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. pkougias@bcm.edu
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.forename: Jean
authors.initials: J
authors.lastname: Bismuth
authors.forename: Tam T
authors.initials: TT
authors.lastname: Huynh
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011312:Pressure; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome