Ruptured abdominal aortic aneurysm treated with open surgical repair (OSR) of a patient with active COVID-19 infection: A case report

Introduction and importance: Patients continued to present vascular emergencies during the most severe phase of the COVID-19 outbreak. An abdominal aortic aneurysm rupture was considered the most life-threatening condition.

Aim: To report a case report of a patient with active COVID-19 infection presenting as a ruptured abdominal aorta aneurysm and treated with open surgical repair at the Department of Vascular Surgery, Royal Jordanian Medical Services (JRMS), Amman, Jordan.

Case presentation: A 69-year-old male presented with an active COVID-19 pneumonic chest infection. Abdominal CT of angiography showed a 4.8-cm infrarenal abdominal aortic aneurysm unsuitable for endovascular aortic aneurysm repair (EVAR). After a rapid deterioration in his general condition, he underwent an exploratory laparotomy which revealed the diagnosis of an AAA rupture. We managed his condition operatively with repair using a tube Dacron graft.

Clinical discussion: Ruptured AAA is considered a devastating lethal vascular emergency with high mortality and morbidity rates and needs emergency intervention n eligible patients. COVID-19 patients with AAA rupture have a significantly increased risk of intervention and require special attention regarding the type of intervention and anaesthesia. The COVID-19 pandemic has changed many guidelines in management vascular emergencies, among them AAA rupture patients. The National Societies guidelines recommended limiting interventions to emergencies only.

Conclusion: The difficulties of surgical intervention, anaesthesia and the appropriate intervention selection increase the burden on the medical staff resisting the obstacles imposed on them by COVID-19 infection.