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Ruptured Aortic Aneurysm - Causes, Symptoms, Diagnosis, and Treatment

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An aortic aneurysm is an abnormal dilation of the aortic lumen. To know more about it, read the article.

Medically reviewed by

Dr. Ghulam Fareed

Published At January 23, 2023
Reviewed AtMay 31, 2023

Introduction

An abdominal aortic aneurysm is an abnormal dilation of the aortic lumen. The most common site is in the abdomen. Abdominal aortic aneurysms (AAA) affect men three times more commonly than women and are estimated to occur in about five percent of men over the age of 60 years. The mortality rate of ruptured abdominal aortic aneurysms is as high as 90 percent. It commonly occurs in old age, among the 65 to 75 year-olds, and emergency conditions are noticed in 75 to 85 year olds. These aneurysms are generally asymptomatic, but ruptured aortic aneurysms require immediate medical intervention.

What Is an Aortic Aneurysm?

Abdominal aortic aneurysm dilates the largest vessel in the abdomen, the aorta, that passes through the stomach and carries blood to the heart. Aorta dilation can occur anywhere in the body, but the most common site is the abdominal aorta. It occurs due to the weakening of the abdominal wall that results in the bulging of the vessel carrying blood and, if left untreated, causes a rupture of the abdominal aorta. Following are the types of aortic aneurysms:

  • Abdominal Aorta Aneurysm - The embolism (vessel blockage by a blood clot or fat globule) of the aorta passing in the abdominal region. It is generally undiagnosed until rupture. Blood clots within the aneurysm sac may be the origin of the blockage of the vessels in the lower limbs. The aorta's chances of being blocked due to blood clots are generally less.

What Are the Causes of Aortic Aneurysms?

Aortic aneurysms result from the aorta's weakening, due to which high blood flow in vessels makes the aorta dilated and can occur in any part of the body. There are some risk factors for aortic aneurysms, but the exact cause is unknown. The following are the causes of aortic aneurysm:

  • The most common cause of an aortic aneurysm is atherosclerosis (abnormalities of an artery).

  • Genetic factor and a specific genetic component, since aortic aneurysm tends to run in families.

  • Hypertension (high blood pressure).

  • Hyperlipidemia (elevated lipid in the blood).

  • Diabetes (high sugar level).

  • Marfan's syndrome (an inherited disorder).

  • Direct trauma to the blood vessel.

  • Inflammation of the arteries (blood vessels carrying oxygen-rich blood).

  • Acute infection in the aorta.

  • Chronic illness to any routes.

Risk Factors:

  • Smoking.

  • Tobacco chewing.

  • Unhealthy lifestyle.

What Are the Symptoms of an Aortic Aneurysm?

The symptoms vary and are dependent on the site of the aneurysm.

1. Thoracic Aneurysm -

  • Acute chest pain.

  • Aortic regurgitation (a heart condition in which blood flows in a backward or reversed direction due to improper closure of the heart valves).

  • Compressive symptoms such as stridor (high-pitched sound while breathing).

  • Hoarseness (heavy or husky voice).

  • The patient may suffer from massive bleeding if an aneurysm erodes into an adjacent structure, such as the food pipe or bronchus.

2. Abdominal Aortic Aneurysm -

  • Abdominal aortic aneurysm affects the lower aorta segment situated below the kidney.

  • Patients suffer from pain in the central region of the abdomen.

  • Backache.

  • Pain in the hip region or groin region.

  • Vomiting.

  • Edema (swelling) in the veins (blood vessels carrying de-oxygenated blood).

  • Pain in lower limbs.

  • Gastrointestinal bleeding.

  • Hematuria (blood in urine).

  • Lightheadedness.

  • Pulsating mass in the abdomen.

How to Diagnose Aortic Aneurysms?

Often aortic aneurysms remain undiagnosed since they are asymptomatic. Even large abdominal aortic aneurysms can be unfelt, so many remain undiagnosed until they rupture. The following ways can diagnose an aortic aneurysm;

  • Physical Examination - On physical examination, physicians observe abdominal swelling or tenderness.

  • X-Ray - X-rays can detect abnormalities in the thoracic region.

  • Ultrasound - Ultrasound is the best way to establish the diagnosis of an abdominal aneurysm and follow a patient with asymptomatic aneurysms that are not yet large enough to warrant surgical repair. The result shows that 65 percent of ruptures can be prevented, and 52 percent of lives can be saved by getting a diagnosis before the break.

  • Computed Tomography (CT) Scan - CT scan provides more appropriate information about the location and size of the aneurysm. Also, it helps in interpreting the affected surrounding areas, if involved, and any other intra-abdominal pathology. It is a standard preoperative investigation but is unsuitable for surveillance because of the high cost and radiation dosage.

What Are the Treatment Options for Ruptured Aortic Aneurysms?

The risk of surgery generally outweighs the risk of rupture until the asymptomatic abdominal aortic aneurysm has reached maximum size, having a diameter of 5.5 centimeters. The following are the treatment options for ruptured aortic aneurysm:

  • Blood Transfusion - It should be transfused after cross-matching for patients with blood pressure drops and high heart rates due to profuse bleeding.

  • Surgery - Most patients with a ruptured abdominal aortic aneurysm do not make it to the hospital. However, if they do, surgery is the treatment of the choice, and the patient is rushed to the operating theater without delay. Surgery helps to clamp the aorta to prevent further blood loss.

  • Open Aortic Abdominal Aneurysm Repair - All symptomatic abdominal aortic aneurysms should be reviewed for repair to relieve the patient of symptoms and because severe pain can result in rupture. Blockage of vessels by blood clots to the limbs is a strong indication for repair, irrespective of its size, as it can result in limb loss. Open aortic abdominal aneurysm repair has been the preferred treatment in both - unruptured and ruptured aneurysms. It entails replacing the aneurysmal segment with a prosthetic graft (usually Dacron). The 30-day fatality for this procedure is approximately five to eight percent for the unruptured asymptomatic abdominal aortic aneurysm. About 10 to 20 percent for emergency symptomatic abdominal aortic aneurysms and 50 percent for the rupture abdominal aortic aneurysm. However, patients with positive surgical and recovery outcomes have survival rates approaching that of the average population.

  • Endovascular Aneurysm Repair - It uses a stent graft, which is introduced through the blood vessels in the groin region. Endovascular aneurysm repair replaces open surgery. It is a worthwhile and profitable procedure and is the preferred treatment for infra-renal abdominal aortic aneurysms. It is possible to treat many suprarenal and thoracoabdominal aneurysms with this technique.

  • Replacement of Aorta - Elective replacement of the ascending aorta may also be considered in patients with evidence of progressive aortic dilation. Although it has its advantages, it carries a mortality risk of five to ten percent.

  • Medication - Beta blocker (Propranolol) reduces the rate of aortic dilation and the risk of rupture if the aneurysm is secondary to Marfan's syndrome.

Conclusion

Most patients with ruptured abdominal aortic aneurysms do not survive in the hospital. It is asymptomatic and can remain unrecognized. However, as soon as the symptoms are noticeable, they should seek immediate medical help. A ruptured abdominal aortic aneurysm represents an emergency and should be treated immediately because it is fatal if left untreated. A healthy lifestyle and smoking cessation can prevent the risk factors of aortic aneurysms.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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