Aortic rupture is an extremely dangerous and rare condition where there is breakage or rupture of the aorta; which is the largest artery in the body. The commonest cause of ruptured aorta is spontaneous rupture of abdominal aortic aneurysm.
Aortic rupture is different from aortic dissection. In aortic dissection there is a tear in the inner wall of the aorta, which can hinder or block the blood flow through the aorta to the heart or abdominal organs.
Depending on its cause, an aortic rupture is classified into 2 types:
- Traumatic aortic rupture, where the aorta ruptures due to any trauma or injury to the chest wall or abdomen, such as could occur in motor vehicle accidents.
- Aortic rupture occurring secondary to an aortic aneurysm, which is the commonest cause.
Signs & Symptoms of Ruptured Aorta
- Patient experiences tearing pain in the abdomen, back, flank or groin.
- Patient loses consciousness.
- Patient becomes hypotensive (low blood pressure) due to hypovolemic shock.
- Patient has tachycardia (rapid heart rate).
- Cyanosis which is bluish discoloration of the skin.
- Disorientation or changes in mental status.
- There is bruising of the flank, which is a sign of retroperitoneal bleeding.
Causes of Ruptured Aorta
Ruptured aortic aneurysm is the most common cause of rupture of the aorta. Other causes include any injury or trauma and iatrogenic causes, i.e. procedure-related causes.
Pathophysiology of Ruptured Aorta
The aortic wall is elastic in nature and requires integrity to stay intact. Rupture occurs as a result of decrease in the strength of the wall where the systemic pressure is more than the wall strength, or any external destruction or damage to the wall of the aorta, such as by any injury or tumor. The bleeding which occurs can be intraperitoneal or retroperitoneal. The rupture can also create an aortointestinal (between the aorta and intestine) or aortocaval fistula.
Investigations for Ruptured Aorta
Aortic rupture or a ruptured aorta is usually suspected when it is too late and patient is close to death either with abdominal trauma or other risk-factors. Ultrasound or CT scan helps in confirming the diagnosis.
Treatment for Ruptured Aorta
Surgery is needed to repair a ruptured aorta. This surgery can be either done using endovascular therapy (EVAR) or as an open aortic surgery. Irrespective of the cause, the aortic rupture is repaired just as the repair of non-ruptured aortic aneurysms is carried out. Before the induction of anesthesia, an aortic occlusion balloon can also be placed for stabilizing the patient and to prevent more blood loss.
Prevention of Ruptured Aorta
If aortic aneurysm is suspected, then to prevent it from rupturing, it is treated prophylactically before any symptoms start. Once there is development of aneurysm, then it does not decrease in size with medicines and surgery is the only treatment available; it can be either open aortic surgery or endovascular aneurysm repair (EVAR).
Prognosis of Ruptured Aorta
The prognosis of ruptured aorta is not good with the mortality rate being around 90%. More than half of the patients die before they even arrive at the hospital and around 90% of them die even before reaching the operating room.