Occult type Ib endoleak not identified on imaging study as a cause of sac expansion refractory to treatment for recurrent type II endoleak

We report a case of serial occurrence different type II endoleak from inferior mesenteric artery and lumbar artery. Despite repeated interventions, gradually expanding aneurysmal sac was eventually followed by impending rupture. In the end, patient required open repair that revealed Ib which is not identified in CT scan or ultrasonography previously. The has been without any specific findings for 5 years recurrence.