Explant of Endovascular Abdominal Aortic Aneurysm Endograft in a Young Patient with Suspected Connective Tissue Disorder: A Case Report and Literature Review

: Endovascular aneurysm repair (EVAR) has changed the management of abdominal aortic aneurysms (AAA), offering a minimally invasive alternative for many patients who are considered unfit for open repair. However, the long-term durability of these endografts raises concerns when used in young patients. : We present the case of a 44-year-old man who underwent EVAR for a 6.8 cm AAA with embolization of the right internal iliac artery at an outside institution two years earlier. The patient presented to our clinic for a second opinion due to kinking of the endograft and an asymptomatic left common iliac artery (CIA) aneurysm. Notably, the patient exhibited connective tissue disorder-like features but had negative genetic testing. Following shared decision-making, we performed a partial explant of the endograft, aneurysmorrhaphy of the left CIA, and right external-to-internal iliac bypass to preserve pelvic perfusion. Six months later, a residual left CIA aneurysm was treated endovascularly with left iliac limb extension. : This case demonstrates the importance of individualized surgical strategies in managing EVAR complications, particularly in complex presentations involving connective tissue disorder-like features. Our experience, supported by the literature, suggests that a partial explant can reduce operative complexity, limit pelvic dissection, and preserve pelvic perfusion in young patients with aneurysmal disease.