Rupture of the aorta commonly occurs at which of the following sites
|A||The Aortic isthmus|
|B||At the junction of the thoracic and the abdominal aorta|
|C||At the junction of the ascending aorta and the arch of the aorta|
|D||At the junction of the arch of aorta and the descending aorta|
a. The most dreaded complication of AAAs is aneurysm rupture.
b. Aneurysms can rupture freely into the peritoneal cavity or retroperitoneum.
c. Free intraperitoneal rupture usually occurs anteriorly and is associated with immediate hemodynamic collapse and a very high mortality rate.
d. Retroperitoneal ruptures are usually posterior and may be contained by the psoas muscle and adjacent periaortic and perivertebral tissue. This type of rupture can occur without significant blood loss initially, and the patient may be hemodynamically stable.
e. Both types of rupture present with back and abdominal pain, pallor, diaphoresis, syncope, or other symptoms related to bleeding and hypovolemic shock. If untreated, AAA rupture is fatal in all cases.
f. Ruptured AAAs require immediate surgical repair.
g. If the patient is unstable and an AAA has been previously diagnosed or a pulsatile mass is present, no further evaluation is needed, and the patient is transferred immediately to the operating room.
h. Stable patients with a questionable diagnosis may undergo CT scanning to confirm the presence of an aortic aneurysm as well as demonstrate its extent, site of rupture, and degree of iliac involvement. In patients not stable enough to undergo CT scanning, an emergency room ultrasound can be used to confirm the presence of an AAA.
i. An acutely expanding or symptomatic aneurysm is prone to rupture and also must be repaired expeditiously.
k. The first priority is to control the hemorrhage by gaining proximal control of the aorta.
l. Resuscitation is best done in the operating room rather than the emergency department, and blood pressure needs to be restored only to levels sufficient to maintain end-organ and cerebral perfusion before induction of anesthesia.