The value of computed tomography in the management of symptomatic abdominal aortic aneurysms

Abstract

The use of computed tomographic (CT) scanning in the diagnosis of ruptured abdominal aortic aneurysm is controversial because the delay created by the procedure, it has been argued, may increase overall mortality. However, if emergency surgery can be avoided in the medically compromised patient, surgical results may improve. To assess the value of CT scanning, we studied the 1983 to 1988 records of 65 hemodynamically stable patients with abdominal aortic aneurysms, who underwent diagnostic CT scanning for acute abdominal or back pain. Twenty-one patients had a history of severe cardiac, renal, or pulmonary disease. The average duration of the examination was 63 minutes; no episodes of hypotension occurred. Subsequently, 17 of 18 patients with ruptured aneurysms had emergency surgery, with 31% morbidity and 29% mortality. Of 44 patients found to have nonruptured aneurysms, 13 had other causes for their pain, nine were not considered surgical candidates, and 24 had elective aneurysmectomies, with 8% morbidity and 0% mortality. In three patients CT scanning excluded the diagnosis of aneurysm. Additional information provided by CT scanning enhanced the safety of the perioperative management of four patients with rupture and 14 without. In conclusion, the delay imposed by obtaining a preoperative CT scan in patients with possible ruptured aneurysm did not adversely affect patient outcome, and the information obtained from it aided significantly in both preoperative and intraoperative management.

The value of computed tomography in the assessment of suspected ruptured abdominal aortic aneurysm

“…For example, in one series of 142 patients who underwent CT (in a 23-month period) for suspected ruptured AAA, 48 (34%) had an aneurysm, and only 13 (9%) had ruptured. 12 Similarly, Kvilekval et al 13 performed CT in 65 of 95 patients (68%) with suspected ruptured AAA, of whom 16 (25%) had either another identifiable cause for their presenting symptoms or no aneurysm.…”

Emergency Non-ruptured Abdominal Aortic Aneurysm

“…3,[17][18][19] Others have argued for an approach where pre-operative assessment is performed and the operation carried out under more optimal conditions than is allowed by an emergency situation. 1,2,4,7,8,11,[20][21][22][23]…”

Spontaneous Rupture of the Ascending Thoracic Aorta in Young Man

“…In a recent study on patients with suspected cardiac cause of out-of-hospital cardiac arrest, Lederer et al [7] reported that in 9 of 91 patients ruptured aortic aneurysm or pericardiac tamponade was found by autopsy.…”