The main symptom of an acute aortic rupture is sudden, extreme pain in the chest and upper abdomen. Patients describe the pain as a “stabbing pain of destruction” that can radiate into the back. The tear in the aorta causes massive internal blood loss, which can lead to circulatory instability and even collapse.
The patients show symptoms of hemorrhagic shock. The severe blood loss leads to reduced blood circulation in the body, resulting in a drop in blood pressure and pulse, accelerated heartbeat (tachycardia) and dyspnea. The bleeding into the abdominal cavity causes a heavy bruise (haematoma), which can press on the surrounding organs and thus cause further pain.
Depending on the location, nerves may also be squeezed, causing loss of sensitivity and paralysis. Depending on the size of the haematoma, it can also be palpable from the outside through the abdominal wall as a pulsating node. A rupture of the aorta into the pericardium, which surrounds the heart from the outside as a taut shell of connective tissue, can lead to a so-called pericardial effusion.
In this case, the escaping blood flows into the pericardium, which is not flexible. As a result, the heart is compressed (pericardial tamponade) and can no longer beat. A pericardial effusion very quickly leads to cardiovascular arrest and must be treated immediately.
Loco typico – Localization
The typical position of a spontaneous aortic rupture is in the abdominal cavity (abdomen), since this is the part of the aorta where aneurysms most frequently occur. In more than 70% of traumatic aortic rupture cases, the loco typico is located at the aortic isthmus, the beginning of the part of the aorta descending from the heart in the chest.
If an aortic rupture is suspected, the emergency doctor must be informed immediately. First responders can remove restrictive clothing (tie, scarves or chains) and place the patient in an upright position to make breathing easier. Unconscious persons should be placed in the stable lateral position until the ambulance arrives.
In general, patients with an aortic rupture receive intensive medical treatment. Essential aspects here are oxygen administration, intubation and artificial respiration. The vital functions, i.e. breathing, body temperature, blood pressure and pulse are constantly monitored.
In order to compensate for the large loss of fluid, the emergency medical team inserts intravenous accesses, through which a rapid volume supply can take place. When treating an aortic rupture, the highest priority is to get the patient to the nearest hospital as quickly as possible, where the rupture is treated as part of an emergency operation. An aortic rupture must be operated on as quickly as possible, otherwise the patient dies within a very short time.
There are two methods of surgical treatment of an aortic rupture: classical direct aortic reconstruction and endovascular stent prosthesis implantation . Which method the surgical team ultimately chooses depends on the size and location of the rupture and the overall condition of the patient. In the classic surgical technique, the chest on the left side is opened and the aorta is exposed.
Then the hole in the aorta is sutured directly or a simple tubular prosthesis is inserted. The patient is fully anesthetized during this difficult procedure. Endovascular stent prosthesis implantation offers a more modern approach to the therapy of an aortic rupture.
In this minimally invasive treatment, a stent is advanced over the pelvic arteries to the aorta. A stent is an implant that is advanced into the vessel where it serves as a replacement for the aortic wall. This procedure does not require a general anaesthetic and a local anaesthetic is usually sufficient.
All major operations on the aorta and the aortic arch are performed using a heart-lung machine. This is a device that replaces the function of the heart and lungs during surgery by diverting blood from the patient’s heart into the machine. There the blood is artificially oxygenated and pumped back into the body, bypassing the heart. In addition, the body is cooled down to about 25 degrees, because cooled cells use much less oxygen than at normal body temperature. These measures give the surgeons enough time to suture the hole in the now bloodless aorta or insert a prosthesis.