Ruptured Abdominal Aortic Aneurysm: Clinical Presentation and Management

Clinical Presentation

The American College of Cardiology recommends that patients with ruptured abdominal aortic aneurysm (AAA) be immediately transferred to a vascular center for urgent repair within 24-48 hours, as this condition is a surgical emergency 1
The pain from AAA rupture typically localizes to the lower back, abdomen, and flank, with back pain occurring in 65-90% of cases, according to the American Heart Association 1
Acute onset pain in the abdomen, back, or flank is the cardinal symptom of impending rupture, and recurrent or refractory pain identifies patients at highest risk of progression to complete rupture, as stated by the American College of Cardiology 1
The infrarenal location of most AAAs explains why lower back and flank pain predominate over upper abdominal symptoms, as noted by the American College of Radiology 2

Hypotension/shock is a critical prognostic indicator and scores 2 points on the AORTAs pretest probability assessment, according to the American Heart Association 3
Blood pressure can fluctuate dramatically as the rupture transitions from contained to free rupture, as reported by the European Society of Cardiology 4, 5
Contained ruptures maintain hemodynamic stability temporarily because perivascular hematoma is sealed off by the pleura, pericardium, retroperitoneal space, and surrounding organs, as explained by the European Society of Cardiology 4
Mortality may be as high as 54% at 6 hours and 76% at 24 hours after the initial rupture event, according to the European Society of Cardiology 4

The American College of Cardiology recommends immediate ICU admission, permissive hypotension (target systolic 70-90 mmHg), and urgent vascular surgery consultation for repair within 24-48 hours for patients with ruptured AAA 1
Endovascular repair is preferred over open repair when anatomically suitable, reducing perioperative mortality from 29-33% to 19-23%, as stated by the American College of Cardiology 1
Fever is present in ≥70% of ruptured AAA cases due to inflammatory response to retroperitoneal blood, according to the American College of Cardiology 1