Ruptured abdominal aortic aneurysm: a surgical emergency with many clinical presentations

Abstract

Ruptured abdominal aortic aneurysm (AAA) is one of the most fatal surgical emergencies, with an overall mortality rate of 90%. Most AAAs rupture into the retroperitoneal cavity, which results in the classical triad of pain, hypotension, and a pulsatile mass. However, this triad is seen in only 25-50% of patients, and many patients with ruptured AAA are misdiagnosed. It is likely that different sites of rupture of AAA determine a variety of common and uncommon clinical presentations, the recognition of which can save many lives. This article reviews the different sites of rupture of infrarenal AAA and explores the evidence behind the various clinical presentations seen in patients with ruptured AAA.

Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone

“…18 Previous work demonstrated that the sites of rupture revealed higher quantities of MMP-8 and MMP-9 and more neovascularization compared with the intact ventral walls of the same patients. 19,20 This indicates that the laterally increased quantity of microvessels and active proteases in intact AAAs described in present study predisposes this region of the AAA as being more vulnerable to rupture.…”

A risk prediction model for mortality in the moribund general surgical patient

“…Undergoing a vascular surgical procedure was a predictor of mortality for patients receiving surgery within 24 hours of admission. Investigation into these procedures demonstrated that 47% of patients receiving a vascular surgery procedure within 24 hours had a postoperative diagnosis of a ruptured abdominal aortic aneurysm, which has been shown elsewhere to have a 90% mortality rate [19]. Interestingly, the type of procedure performed was not associated with inpatient mortality for patients undergoing surgery at least 24 hours after admission.…”

Tratamento de Aneurisma da Aorta Abdominal por PEVAR Complicado de Pseudo-Aneurisma Femoral

“…10 Considera-se que apresenta critério operatório quando o seu diâmetro transversal é superior a 5,5 cm ou se documenta um crescimento superior a 0,5 cm no período de seis meses, independentemente de qual o seu diâme-tro. 11 A sua identificação precoce e correção atempada constituem assim uma necessidade, numa tentativa de prevenir um desfecho potencialmente trágico.…”