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Ruptured Aortic Aneurysm


Presentation

  • Hypertension was the most predisposing factor and was present in 29 (58.0%) of 50 patients. On admission, hypertension was present in 26 (56.5%) of 46 patients, and hypotension was present in 14 (30.4%) of 46 patients.[ncbi.nlm.nih.gov]
  • We report a patient with an atypically presenting ruptured aortic aneurysm masquerading as phlegmasia cerulea dolens.[ncbi.nlm.nih.gov]
  • Among several other atypical clinical presentations, back and leg pain may ensue from a contained ruptured abdominal aortic aneurysm.[ncbi.nlm.nih.gov]
  • Abstract CT scans were obtained in five patients who presented with abdominal pain and were found to have an abdominal aortic aneurysm without evidence of hypovolaemia.[ncbi.nlm.nih.gov]
Intermittent Claudication
  • A 68-year-old man with a history of hypertension, intermittent claudication, and smoking presented with asthenia, macrohematuria, and mild back pain, as well as edema and blue mottling of the lower limbs and abdomen for 24 hours.[ncbi.nlm.nih.gov]
Crying
  • I miss him terribly and cry every day. Earlier in the day he passed away, it was Sunday he was just fine we watched his favorite football team together on TV all afternoon. Nothing was wrong with him.[connect.legacy.com]
Abdominal Pain
  • Most cases show evidence of a large arteriovenous fistula which can, on occasions, dominate the clinical picture, e.g. cyanosed lower extremities or cardiac failure, but abdominal pain is the major feature.[ncbi.nlm.nih.gov]
  • Abstract CT scans were obtained in five patients who presented with abdominal pain and were found to have an abdominal aortic aneurysm without evidence of hypovolaemia.[ncbi.nlm.nih.gov]
  • Additional Comments The most common symptom of an abdominal aortic aneurysm is abdominal pain or discomfort. The patient has a history of aortic aneurysms.[millerandzois.com]
  • Clinical findings Onset may be abrupt or gradual; pulsatile abdominal mass, early satiety, nausea, vomiting, constipation, pain or claudication, waxing and waning abdominal paining that may remit spontaneously, rebound tenderness.[medical-dictionary.thefreedictionary.com]
  • Non-abdominal causes of abdominal pain Failing to consider extra-abdominal causes in the patient presenting with abdominal pain is a frequent pitfall. Several life-threatening illnesses can present with abdominal pain only.[doi.org]
Severe Abdominal Pain
  • Many patients with this man's history are told by their doctors f you've got any severe abdominal pain (or back or flank pain) to the emergency room and tell them you have an aneurysm.[millerandzois.com]
  • abdominal pain and a known abdominal aortic aneurysm.[theanesthesiaconsultant.com]
  • abdominal pain radiating into back faintness, syncope, hypotension Prognosis:64-94% die before reaching hospital Increased risk: size 6 cm, growth 5 mm / 6 months, pain tenderness Peripheral embolization Infection Spontaneous occlusion of aorta Prognosis[learningradiology.com]
  • It can also elucidate other causes of severe abdominal pain [ 10 ].[doi.org]
Acute Abdomen
  • The differential diagnosis for ruptured AAA involves other causes of abdominal pain , including acute abdomen . Investigations If an aneurysm is ruptured, investigations need to be swift and pertinent.[patient.info]
  • The differential diagnosis for ruptured AAA involves other causes of abdominal pain, including acute abdomen. Investigations If an aneurysm is ruptured, investigations need to be swift and pertinent.[patient.info]
  • This also serves to exclude other causes of acute abdomen and predict endograft size. Some are concerned that the extra time required for imaging may adversely affect outcome but recent research suggests this is not the case.[ceaccp.oxfordjournals.org]
  • World J Emerg Surg 2014, 9: 6. 10.1186/1749-7922-9-6 PubMed Central View Article PubMed Google Scholar Kauvar DR: The geriatric acute abdomen. Clin Geriatr Med 1993, 9: 547–58.[doi.org]
Colic
  • Pain in the abdomen and back can suggest passage of a stone down the tube from the kidney (ureteric colic). Pain and tenderness in the lower abdomen may lead to suspicion of colonic spasm or diverticulitis.[familydoctor.co.uk]
  • A frequent misdiagnosis in patients with back pain and microscopic hematuria is renal colic.[doi.org]
  • […] repair Presentation Unruptured Aneurysm Signs and Symptoms Most AAAs are asymptomatic until expansion or rupture occurs Pain is a common symptom when symptoms are present Abdominal, back and/or flank pain Acute pain associated with a AAA can mimic renal colic[coreem.net]
Abdominal Bruit
  • Careful examination of all patients with a ruptured aneurysm, particularly listening for an abdominal bruit, will usually allow the diagnosis of aortocaval rupture to be made.[ncbi.nlm.nih.gov]
  • Free rupture of the AAA will present in same way as any ruptured AAA Formation of a large arteriovenous (AV) fistula may occur if there is no external AAA leak Signs and Symptoms ( Cinara 2005 ) Palpable mass (80-90%) Abdominal bruit (75%) Palpable thrill[coreem.net]
Vascular Disease
  • Tim Resch, MD, PhD, is with the Vascular Center, Department of Hematology and Vascular Diseases at Skane University Hospital in Malmö, Sweden. He has disclosed that he is a consultant to Cook Medical. Dr.[evtoday.com]
  • Diseases Cardiovascular Diseases Aortic Diseases Aneurysm, Ruptured Rupture Wounds and Injuries Tranexamic Acid Antifibrinolytic Agents Fibrin Modulating Agents Molecular Mechanisms of Pharmacological Action Hemostatics Coagulants[clinicaltrials.gov]
  • What Is Vascular Disease? Most Americans are familiar with heart disease and with the consequences of blockages in the vessels that carry blood to and from the heart.[vascularweb.org]
  • SEARCH METHODS: The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12).[ncbi.nlm.nih.gov]
Arthritis
  • Pain concentrated in the back can be confused with acute lumbar back pain from arthritis of the spine or a disc problem – especially if leakage of blood around the nerves in the lumbar area lead to ‘sciatica’ – pain radiating down the leg.[familydoctor.co.uk]
  • Increases in the musculoskeletal disorders were driven by the category other musculoskeletal disorders; causes with high number of death in this category were systemic lupus erythematosus, systemic sclerosis (scleroderma), pyogenic arthritis, and chronic[ncbi.nlm.nih.gov]
Panic Attacks
  • After his second panic attack Max sought help from his GP, who referred him for counselling. “The counselling has really helped and I’m on medications now too,” he says.[bhf.org.uk]
Screaming
  • After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota.[theanesthesiaconsultant.com]
Incontinence
  • Nevertheless, prompt diagnosis may be difficult due to many different symptoms, such as severe chest pain, back pain, abdominal pain, cold sweat, dyspnea, disturbance of consciousness, vomiting, incontinence, melena, etc.[healio.com]

Workup

  • And he survived waiting several hours at his hospital for workup and eventual transfer which is a stress test.[vascsurg.me]
  • Aneurysm was noted during workup for back pain, and CT was ordered after AAA was identified on radiography. No evidence of rupture is seen. Signs and symptoms AAAs are usually asymptomatic until they expand or rupture.[emedicine.medscape.com]
Ventricular Hypertrophy
  • The preoperative electrocardiogram displayed left ventricular hypertrophy and was suggestive for anterior ischemia. However, the patient gave no history of angina, dyspnea, hypertension, or diabetes.[anesthesiology.pubs.asahq.org]

Treatment

  • The patient underwent open treatment for a ruptured abdominal aortic aneurysm in another hospital. The procedure was complicated by extreme blood loss which prevented concommitant treatment of two large iliac aneurysms.[ncbi.nlm.nih.gov]
  • PURPOSE: To evaluate a homemade tricuspid valve placed in the short limb of a bifurcated aortic stent-graft to facilitate endovascular treatment of ruptured abdominal aortic aneurysms (AAA).[ncbi.nlm.nih.gov]
  • Criteria are needed to identify patients with a poor prognosis so that treatment and resources may be directed to those with a better outlook.[ncbi.nlm.nih.gov]
  • CONCLUSION: Endovascular treatment of RAAA is feasible, and the overall post-operative mortality and morbidity of RAAA can probably be reduced by implementation of RAAA.[ncbi.nlm.nih.gov]
  • We report a case of successful endovascular treatment in a patient with ruptured abdominal aortic aneurysm by occluding the abdominal aneurysm using the Amplatzer Vascular Plug (AVP II).[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis May be fatal if untreated. ruptured aortic aneurysm Surgery The transmural disruption of the integrity of the aorta, which usually occurs in a background of aortic dissection Clinical Onset may be abrupt or gradual; pulsatile abdominal mass,[medical-dictionary.thefreedictionary.com]
  • Criteria are needed to identify patients with a poor prognosis so that treatment and resources may be directed to those with a better outlook.[ncbi.nlm.nih.gov]
  • However, there is no scientific evidence that aneurysm size has any correlation with a better or worse prognosis after rupture.[scielo.br]
  • Prognosis No more than one in three patients with a ruptured aortic aneurysm will reach hospital alive; 20% of those who do, fail to reach theatre. Delay in diagnosis is likely to result in death.[patient.info]

Etiology

  • This book considers mainly etiology, pathogenesis, and pathophysiology of aortic aneurysms (AA) and aneurysm rupture and addresses anyone engaged in treatment and prevention of AA.[intechopen.com]
  • The maximum decrease in blood pressure usually occurs 15–30 min after the subarachnoid injection. [1] Therefore, the abrupt onset of cardiac arrest in our patient suggests presence of other etiologic factors, such as RAAA, responsible for the circulatory[anesthesiology.pubs.asahq.org]
  • (See Etiology .) AAAs generally affect elderly white men. Smoking appears to be the risk factor most strongly associated with AAA.[emedicine.medscape.com]

Epidemiology

  • Epidemiology Ruptured abdominal aortic aneurysms (AAAs) cause 12,000 deaths per year; 8,000 of these are infra-renal. [ 2 ] Women are much less frequently affected.[patient.info]
  • Epidemiology Frequency United States The incidence of aortic aneurysm is 5.9 cases per 100,000 person-years. [1] Mortality/Morbidity The cumulative risk of rupturing a thoracic aortic aneurysm (TAA) is related to aneurysm diameter.[emedicine.medscape.com]
  • Abdominal Aortic Aneurysm Classification Abdominal Aortic Aneurysm Management Abdominal Aortic Aneurysm Epidemiology Abdominal Aortic Aneurysm History[news-medical.net]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Degenerative changes in the wall of the aorta lead to cystic medial necrosis.[emedicine.medscape.com]
  • This book considers mainly etiology, pathogenesis, and pathophysiology of aortic aneurysms (AA) and aneurysm rupture and addresses anyone engaged in treatment and prevention of AA.[intechopen.com]
  • We report a case of cardiac arrest and RAAA during spinal anesthesia and discuss the pathophysiologic changes associated with cardiac arrest after spinal anesthesia in context with RAAA.[anesthesiology.pubs.asahq.org]
  • Pathophysiology The development of AAAs results from alterations in the aortic wall connective tissue. Elastin and collagen fibres provide most of the tensile strength of the aortic wall.[ceaccp.oxfordjournals.org]

Prevention

  • The procedure was complicated by extreme blood loss which prevented concommitant treatment of two large iliac aneurysms.[ncbi.nlm.nih.gov]
  • If caught early, treatments can be used to prevent rupture of the aneurysm.[clinicaltrials.gov]
  • Preventive Services Task Force. Ann Intern Med. 2005;142:203–11.[cdc.gov]
  • The researchers say that, in principle, if raising HDLs can be induced using a drug, it could offer a preventative measure to reduce the chance of an aneurysm developing for individuals considered at high risk of aneurysms.[sciencedaily.com]
  • Christopher Washington Ruptured abdominal aortic aneurysms (rAAA) are associated with an overall mortality rate of over 80%, and, according to the US Centers for Disease Control and Prevention, were the primary cause of death in over 11,000 patients in[vascularnews.com]

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