Ruptured Aortic Aneurysm

Overview

A ruptured aortic aneurysm is a medical emergency. If you suspect one, call emergency services (911 or your local number) right away.

The aorta is the large artery that carries blood from the heart to the rest of the body. An aneurysm is a weak, bulging area in its wall. When that bulge grows too large or the wall becomes too weak, it can tear open, causing rapid and heavy internal bleeding. This is a ruptured aortic aneurysm.

Rupture can happen in the abdominal section of the aorta (a ruptured abdominal aortic aneurysm) or the chest section (thoracic). It is one of the most dangerous events in medicine because so much blood can be lost so quickly. Survival depends on recognizing the warning signs and getting emergency surgery as fast as possible.

Symptoms

These symptoms require an immediate emergency call. A rupture often comes on suddenly and dramatically, although a leaking aneurysm can sometimes cause warning symptoms before a full rupture.

• Sudden, severe, and persistent pain in the abdomen, back, flank, or chest
• Pain that may be described as tearing or ripping
• A pulsing sensation in the abdomen before rupture
• Dizziness, fainting, or loss of consciousness
• Cold, clammy, pale skin and a rapid heartbeat
• Low blood pressure and signs of shock

Anyone known to have an aortic aneurysm who develops sudden severe pain should treat it as a rupture until proven otherwise and seek emergency care.

Causes

A rupture occurs when the wall of an existing aneurysm can no longer withstand the pressure of blood inside it. Factors that weaken the wall or raise the pressure include:

• Atherosclerosis: Hardening and weakening of the artery walls, the most common underlying process.
• High blood pressure: Sustained high pressure stresses the weakened wall.
• Large or rapidly growing aneurysms: The bigger the bulge, the higher the risk of rupture.
• Connective tissue disorders: Inherited conditions that weaken artery walls.
• Trauma or infection: Less common contributors that damage the aortic wall.

Risk Factors

• A known, especially large, aortic aneurysm
• Smoking, which is one of the strongest risk factors
• High blood pressure
• Older age, particularly in men
• A family history of aortic aneurysms
• Atherosclerosis or high cholesterol
• Certain inherited connective tissue disorders

Diagnosis

When rupture is suspected, diagnosis happens rapidly in the emergency setting:

• Immediate assessment: Blood pressure, pulse, and signs of shock are checked at once.
• CT scan: The fastest, most accurate way to confirm a rupture in a stable enough patient.
• Ultrasound: Can be done at the bedside to detect an aneurysm and free blood.

Because every minute matters, treatment often begins while testing is still under way. Unruptured aneurysms, by contrast, are usually found earlier through screening or imaging done for other reasons, allowing planned repair.

Treatment

A ruptured aortic aneurysm requires emergency surgery; there is no way to treat it at home. Care focuses on stopping the bleeding and repairing the aorta.

• Emergency resuscitation: Intravenous fluids and blood transfusions support circulation while the patient is prepared for surgery.
• Open surgical repair: The damaged section of aorta is replaced with a synthetic graft.
• Endovascular repair (EVAR): In selected cases, a stent-graft is placed through the blood vessels to seal the rupture from the inside.

Even with rapid treatment, a rupture is extremely serious. This is why doctors monitor known aneurysms and repair them electively before they reach a dangerous size.

Prevention

• Stop smoking, the single most important step
• Keep blood pressure well controlled
• Manage cholesterol and follow heart-healthy habits
• Attend recommended aneurysm screening if you are eligible
• If you have a known aneurysm, keep all monitoring appointments and discuss timing of repair
• Know your family history and tell your doctor

When to See a Doctor

Call emergency services immediately for sudden, severe pain in the abdomen, back, flank, or chest, especially if you feel faint, have cold clammy skin, or know you have an aortic aneurysm. Do not drive yourself. For non-emergency concerns, see your doctor if you have risk factors such as smoking, high blood pressure, or a family history of aneurysm, since screening can detect an aneurysm before it ruptures and allow planned, much safer repair.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Abdominal aortic aneurysm - Symptoms and causes.
2. National Heart, Lung, and Blood Institute (NHLBI). Aortic Aneurysm.
3. MedlinePlus, U.S. National Library of Medicine. Aortic aneurysm.
4. Centers for Disease Control and Prevention (CDC). Aortic Aneurysm.