Factors promoting rupture of abdominal aortic aneurysms

in Acta Chirurgica Belgica (2005), 105(1), 1-12

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of ... [more ▼]

The risk for rupture of an abdominal aortic aneurysm is widely believed to be related to its maximum diameter. Rupture occurs at the site of maximum wall stress, when it exceeds the tensile strength of the aortic wall. Basic research confirmed that peak wall stress and aortic wall biodegradation contribute to the mechanism of aneurysm rupture. In order to highlight the role of loss in wall strength and increase in focal peak stress, the authors reviewed recent literature. The clinical relevance of these recent insights in the etiopathogenesis of aneurysm rupture is analysed. [less ▲]

Chronic Rupture of Abdominal Aortic Aneurysm Manifesting as Crural Neuropathy

in Annals of Vascular Surgery (2001), 15(3), 405-11

Chronic rupture of abdominal aortic aneurysm (AAA) resulting in unusual clinical manifestations can occur if the resistance of structures surrounding the aorta is sufficient to contain hemorrhage. In this ... [more ▼]

Chronic rupture of abdominal aortic aneurysm (AAA) resulting in unusual clinical manifestations can occur if the resistance of structures surrounding the aorta is sufficient to contain hemorrhage. In this report, we describe five cases of chronic ruptured AAA in which the presenting feature was crural neuropathy. All patients were male with a mean age of 74 +/- 1.8 years. At the time of presentation, crural neuropathy had been ongoing for 3 to 9 weeks. In three cases, AAA was not initially suspected because an inadequate clinical examination was performed (not in the vascular surgery department) and because of the small diameter of the aorta in relation to the patient's morphology. Two patients had one episode of hypotension that was wrongly attributed to vagal attack. Abdominal CT scanning was always diagnostic of chronic rupture. In two cases, rupture was associated with erosion of the body of one or more vertebrae and laboratory evidence of inflammation, i.e., increase in sedimentation rate and fibrinogen level. The mean diameter of the AAA was 7.1 +/- 0.9 cm (range 5-10 cm). All patients underwent midline laparotomy, which was performed under emergency conditions in two cases, under semi-emergency conditions in one case, and electively in two cases. Perforation was consistently located on the posterolateral wall of the aorta and varied from 1 to 3 cm in length. Repair was performed using an aortobifemoral prosthesis in four cases, and a straight tube in one case. The patient who underwent emergency surgery died 4 days after the procedure. The remaining four patients recovered uneventfully and were discharged after 10 days. In the elderly, ruptured AAA should be included in the differential diagnosis of crural neuropathy. An episode of hypotension, regardless of its duration, in an elderly patient should be given serious consideration as a possible sign of ruptured AAA with ongoing retroperitoneal hemorrhage. [less ▲]