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Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146(24):e334-e482. doi:10.1161/CIR.0000000000001106
Erbel R, Aboyans V, Boileau C, et al; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014 Nov 1;35(41):2873-926. doi: 10.1093/eurheartj/ehu281. Epub 2014 Aug 29. Erratum in: Eur Heart J. 2015 Nov 1;36(41):2779. PubMed PMID: 25173340.
Definition, Etiology, PathogenesisTop
Contained rupture of aortic aneurysm refers to an acute event of disruption of the aortic wall (sometimes also involving later formation of a pseudoaneurysm) associated with the development of perivascular hematoma that is sealed off by periaortic structures: the pleura, pericardium, retroperitoneal space, or adjacent organs.
Clinical Features and Natural HistoryTop
Symptoms:
1) A sudden-onset acute pain in the chest or back (or both). In patients with a thoracoabdominal aortic aneurysm, abdominal pain may be present.
2) Acute respiratory failure due to aortic rupture into the left hemithorax.
3) Rarely, bleeding from the respiratory tract or from the upper gastrointestinal tract.
The closer the location of rupture to the aortic valve, the higher the risk of death. Over 75% of patients die within 24 hours.
DiagnosisTop
Suspected aortic rupture is an indication for urgent computed tomography angiography (CTA) without contrast enhancement to detect possible intramural hematomas and subsequently for contrast-enhanced CTA to locate the rupture.
TreatmentTop
Urgent or emergent surgical or endovascular treatment, regardless of the aneurysm size, is indicated to avoid “free rupture” or bleeding into an adjacent organ. If the patient’s anatomy is appropriate, an endovascular approach may be preferred over open surgery in urgent or emergent circumstances due to lower procedural risk.
