Case Report: Successful Management of a Ruptured Abdominal Aortic Aneurysm With Concurrent Acute Myocardial Infarction in an 84-Year-Old Male.

Rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event with mortality rates historically approaching 80%, often compounded by significant coronary artery disease. We present the challenging case of an 84-year-old man who presented with a contained AAA rupture and a synchronous acute myocardial infarction. Given his hemodynamically stable but precarious state, our team prioritized immediate percutaneous coronary intervention with drug-eluting stents, which mandated dual antiplatelet therapy (DAPT). An ensuing attempt at endovascular repair (EVAR) failed because of extensive iliac calcification and a femoral artery injury that occurred during access. Consequently, open surgical repair was undertaken on hospital Day 5 despite ongoing DAPT-a high-risk maneuver that proceeded without major bleeding complications. This exceptional outcome underscores that, in select patients with a contained rupture, a strategy of prioritized coronary revascularization followed by open repair while on DAPT can be successful, highlighting the vital importance of adaptable, multidisciplinary decision-making. At 2.5 years, the patient remains alive and functionally independent, confirming the durability of this approach.