Aortic rupture

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Aortic rupture is the rupture or breakage of the aorta, the largest artery in the body. Aortic rupture is a rare, extremely dangerous condition. The most common cause is an abdominal aortic aneurysm that has ruptured spontaneously.

Aortic rupture is distinct from aortic dissection, which is a tear through the inner wall of the aorta that can block the flow of blood through the aorta to the heart or abdominal organs

An aortic rupture can be classified according to its cause into one of the following main types:

Signs and symptoms[edit]

Symptoms[edit]

  • Tearing pain, located in the abdomen, flank, groin, or back
  • Loss of consciousness

Signs[edit]

Causes[edit]

The most common cause of aortic rupture is a ruptured aortic aneurysm. Other causes include trauma and iatrogenic (procedure-related) causes.

Mechanism[edit]

The wall of the aorta is an elastic structure which requires integrity. Rupture results from either loss of wall strength to the point at which systemic pressure is greater than wall strength, or external destruction of the wall of the aorta, by a tumor or traumatic means.

The bleeding can be retroperitoneal or intraperitoneal, or the rupture can create an aortocaval or aortointestinal (between the aorta and intestine) fistula.

Diagnosis[edit]

Diagnosis is often suspected in patients in extremis (close to death) with abdominal trauma or with relevant risk-factors. Diagnosis is confimed quickly in the Emergency room by ultrasound or CT scan.

Prevention[edit]

Aortic aneurysms are treated prophylactically (prior to symptoms) to prevent rupture. Once an aneurysm has developed, it does not regress, so the only treatment is surgery, either endovascular aneurysm repair (EVAR) or open aortic surgery.

Treatment[edit]

Aortic ruptures can be repaired surgically via open aortic surgery or using endovascular therapy (EVAR), regardless of cause, just as non-ruptured aortic aneurysms are repaired. An aortic occlusion balloon can be placed to stabilize the patient and prevent further blood loss prior to the induction of anesthesia.

Prognosis[edit]

Mortality from aortic rupture is up to 90%. 65–75% of patients die before they arrive at hospital and up to 90% die before they reach the operating room.[2]

References[edit]

  1. ^ Ruptured Aortic Aneurysm at Patient UK. Original Author: Dr Laurence Knott. Current Version: Dr Gurvinder Rull. Peer Reviewer: Dr Hannah Gronow. Last Checked: 16/05/2012
  2. ^ Brown, LC; Powell, JT (September 1999). "Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.". Annals of surgery 230 (3): 289–96; discussion 296–7. PMID 10493476.