Limited culprit-vessel reperfusion before endovascular aneurysm repair for ruptured abdominal aortic aneurysm with concurrent inferior ST-segment elevation myocardial infarction.

A 54-year-old man presented with sudden abdominal and low back pain, hypotension, inferior ST-segment elevation, and recurrent ventricular fibrillation and tachycardia. Computed tomography showed a ruptured infrarenal abdominal aortic aneurysm. Coronary angiography in a hybrid operating room demonstrated acute thrombotic occlusion of the distal right coronary artery. As malignant arrhythmias threatened safe aneurysm repair, limited culprit-vessel reperfusion with thrombus aspiration and balloon angioplasty was performed without stenting. Endovascular aneurysm repair followed immediately in the same room. This case illustrates that limited coronary reperfusion may bridge selected patients with ruptured abdominal aortic aneurysm and true ST-segment elevation myocardial infarction to endovascular aneurysm repair.