Chronic Contained Rupture of Abdominal Aortic Aneurysm

Abstract

Computed tomography in a 74-year-old man with intermittent claudication revealed an abdominal aortic aneurysm, retroperitoneal hematoma, vertebral erosion, and total aortic occlusion. Surgery was delayed for 9 months after definitive diagnosis of contained rupture of the aortic aneurysm to allow treatment for ischemic heart disease and cardiac failure. After interposing a Y-shaped woven Dacron graft, the intermittent claudication was alleviated. The postoperative course was uneventful.

Chronic contained rupture of abdominal aortic aneurism complicated with aortic occlusion: a case report

“…The fact that CCR-AA is a rare condition further confounds diagnosis. Although there have been several reported cases in recent years of CCR-AAA with vertebral invasion, we could find only one reported case of CCR-AAA with abdominal aortic occlusion [4]. In the report by Yokomuro et al, complication of CCR-AAA by infrarenal abdominal aortic occlusion was confirmed.…”

“…A CCR-AAA is a well-known, extremely rare subtype of AAA that was first reported by Szilagyi et al in 1961 [1–3]. It is characterized by low blood loss and stable hemodynamics, which are due to hemostasis by tissue peripheral to the retroperitoneum when the aortic aneurysm ruptures [4, 5].…”

“…The diagnostic criteria for CCR-AAA consist of the following: (1) known AAA; (2) previous pain symptoms; (3) stable condition and normal hematocrit; (4) a CT scan showing a retroperitoneal hematoma; and (5) pathological confirmation of an organized hematoma [1, 2]. Although back pain is common, cases of CCR-AAA present with a wide variety of clinical findings, including cases which are asymptomatic [4–6]. The diagnosis of CCR-AAA thus poses a dilemma.…”

“…Diseases from which CCR-AAA must be distinguished include retroperitoneal tumor and abscess [1, 2]. CT is a useful modality for diagnosing CCR-AAA; it shows a well-defined soft-tissue density mass, inside which there is often no contrast effect, adjacent to the aortic wall [4]. In addition to CT, FDG-PET is also reported to be effective for the definitive diagnosis of CCR-AAA.…”

“…However, abdominal aortic occlusion had already been observed in the initial examination. Nothing was stated concerning a relationship between the aortic occlusion and CCR-AAA [4].…”