Aortic rupture

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:

• Traumatic aortic rupture
• Aortic rupture secondary to an aortic aneurysm

Signs and symptoms

Symptoms

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

Signs

• Low blood pressure from hypovolemic shock
• Fast heart rate
• Blue discoloration of the skin
• Altered mental status
• Bruising of the flank, a sign of retroperitoneal bleeding.

Causes

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

Mechanism

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

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

Prevention

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

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

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.