An aortic aneurysm is a weak spot in the wall of the biggest artery in the body, called the aorta, causing the artery to balloon outward at that point. A ruptured aortic aneurysm is a life-threatening condition where the aorta bursts and catastrophic internal bleeding occurs. As the rupture generally happens suddenly, the first signs may be pain and collapse and, if successful surgical treatment is not carried out straight away, these are closely followed by death. In those patients where a ruptured aortic aneurysm is not immediately fatal, there will generally be pain in the back or abdomen, low blood pressure and a pulsating abdominal lump.
Other signs associated with a ruptured aortic aneurysm include a pale, sweaty appearance, a weak, rapid pulse, and fainting or vomiting. The pulsating lump typically found in the abdomen is the swollen, ruptured aortic aneurysm itself, and this is often found to hurt when examined. It is likely to be situated above and slightly to the left of the umbilicus, or navel. Sometimes, on listening to the lump through a stethoscope, sounds of abnormal blood flow can be heard.
Treatment of a ruptured aortic aneurysm requires emergency surgery. Open surgery may be carried out to replace the leaking section of the aorta with a synthetic graft, made from material with elastic properties. Alternatively, keyhole surgery may be used in some cases. Here, a tube called a stent-graft is inserted through a leg vein, and guided into the defective part of the aorta. This technique has the disadvantage that sometimes patients require further surgery, due to movement of the tube.
As a ruptured aortic aneurysm can so often be fatal, it is best to detect aneurysms early if possible, so they can be monitored. Surgery may then be carried out if they grow too large, before there is a chance of rupture. This is difficult in practice, because many aneurysms show no signs when they are small, and it is not easy to predict how fast they will grow. Causes of aneurysms include high blood pressure, narrowing of the arteries and some inherited diseases where the tissues develop abnormally. Smoking is the main risk factor, and aneurysm patients are advised to quit, to eat healthily, exercise regularly and take blood pressure medication if required.
Sometimes, an aortic aneurysm leads to what is called an aortic dissection. This is where the lining of the aorta tears and blood leaks into the wall, causing severe pain and loss of the pulse. Surgical repair is often required, although some types of dissection can be treated using pain relief and drugs to lower blood pressure.