Objective: To demonstrate aneurysm sac expansion in the face of a type II endoleak and its treatment with open ligation of multiple side branch endoleaks.

Methods: An 81-year-old patient had undergone elective endovascular repair of a 6.3-cm infrarenal abdominal aortic aneurysm in September 1999. Routine spiral computed tomographic angiography at 10 months disclosed a type II endoleak; the aneurysm sac diameter had grown to 7.4 cm. Selective angiography revealed multiple lumbar endoleaks and a patent inferior mesenteric artery. Laparotomy and sacotomy was performed, confirming the presence of pulsatile type II endoleaks, which were ligated successfully. The patient made a full postoperative recovery.

Conclusions: Type II endoleaks may cause aneurysm expansion. Open repair of multiple type II endoleaks is feasible and may be useful where endovascular or laparoscopic techniques are at high risk of procedural failure, such as multiple endoleak channels.