A 70-year-old man presented with a late Type Ia endoleak following an endovascular aortic repair (EVAR) procedure for an abdominal aortic aneurysm (AAA) performed at my institution 10 years ago. An additional aortic extension cuff was placed above the previously implanted aortic stent graft using an endovascular approach. Despite this intervention, the Type Ia endoleak persisted, and it was concluded that further endovascular treatments would be insufficient, necessitating surgical repair. The patient subsequently underwent open repair surgery due to the risk of rupture. The procedure involved removal of the stent graft, aneurysmectomy, and replacement with a bifurcated aortoiliac graft. Additionally, a suprapubic femoro-femoral crossover bypass surgery was performed to resolve the intimal damage to the left common iliac artery that occurred during stent graft removal. Open repair offers a definitive solution for complex endoleaks when endovascular methods are ineffective. However, the removal of the stent graft can result in arterial intimal injury, necessitating additional measures such as a suprapubic femoro-femoral crossover bypass to ensure adequate blood flow.