Prognosis of aortic rupture
The forecast depends on many factors. The larger the crack is, the later it is detected and the more unfavourable the location, the death rate can be over 80%. If the aortic tear is treated early, the mortality rate can drop to 20%.
The chances of survival in the event of an aortic tear, which usually occurs in the form of a “ruptured (torn) aortic aneurysm” (not to be confused with “aortic dissection“), depend greatly on the location of the tear and the area into which the blood flows. A distinction is made between covered and free bleeding. In free bleeding, the blood flows into the abdominal cavity.
Since the abdominal cavity can absorb a large volume, there is an enormous loss of blood within a very short time. In the case of submerged bleeding, the blood flows into a space behind the abdominal cavity, the so-called “retroperitoneum”. This area can only absorb a limited volume, which is why there is less blood loss.
In the case of an aortic rupture, only patients with a submerged bleeding usually reach the hospital alive. This is approximately 50%. Of these 50%, however, only about 70% make it to the operating theatre.
The survival rate of emergency surgery for a ruptured aortic aneurysm is approximately 60% and depends on the individual care within the hospital and the experience of the surgeons. The main problem for patients with a traumatically caused aortic rupture (e.g. in an accident) is that these patients are usually polytraumatically injured. A polytrauma is when two or more injuries are present that are life-threatening.
Therefore, the cause of death is usually not even the cause of the rupture of the aorta. In general, the concomitant injuries determine the prognosis and the course of the aortic rupture. If the aortic rupture is the result of aortic dissection, the prognosis varies depending on the location of the rupture.
In the case of a tear in the aortic arch or even closer to the point of exit from the heart (ascending aorta), the lethality rate (the probability of dying from the aortic tear) in the first 48 hours is approximately 1% per hour. The one-year survival probability for this type and location of injury is 5% without surgery. It is clear that urgent and rapid action is required here.
If an operation is performed in time, the one-year survival probability is 60-80% and depends on the patient’s other health. If the aortic tear lies in the descending part of the aorta (aorta descendens), the survival probability with drug treatment of the aortic tear is 60-80%. The consequences of an aortic rupture can be devastating.
In most cases, the heavy bleeding initially leads to a reduced supply of blood to the organs located behind the defective area. With increasing blood loss, organs in front of the defect are also affected, because the circulating blood volume is no longer sufficient for supply. If the rupture is located very high up before the vessels to the head and brain leave the aorta, this can result in loss of consciousness, neurological deficits or a stroke.
Depending on the severity and duration of the undersupply, this can result in permanent damage even if the patient is rescued. If the tear with the associated bleeding is close to the heart, its function may also be restricted. For example, the aortic valve, the valve between the heart and the aorta, may no longer close properly, which further reduces the blood flow.
Compression of the heart by the massive space requirement or by bleeding into the pericardium (pericardial effusion) also impairs the work of the heart, causing massive pain, shortness of breath and, in the worst case, death of the patient. As a result of a deficiency in the kidneys, acute renal failure can occur, which after a short time leads to the kidney or kidneys ceasing to function. If the patient’s life can be saved, this results in a life-long renal replacement therapy (dialysis) or the necessity of a kidney transplant.
The undersupply of organs of the gastrointestinal tract leads to necrosis as a late consequence. This means that parts of the intestine die and have to be removed. Depending on the section of the gastrointestinal tract, this means a more or less good prognosis for the patient.
Overall, aortic rupture is considered to be extremely problematic in prognosis. Since an aortic tear is almost always associated with massive bleeding, only about half of all untreated patients would survive. However, with advanced drug therapy and modern surgical techniques, the mortality rate can be more than halved.
Thus, after one month, about 80% of patients who have suffered an aortic dissection are still alive. Emergency surgery for an aortic tear is a high-risk operation. Immediately after the operation, the operated area may leak, resulting in secondary bleeding.
The high blood loss that already occurs during the original rupture has many consequences. Wound healing is slower, the circulation is weakened and the missing white blood cells also cause problems for the immune system. In addition, the blood transports the oxygen in the body and this is only possible if there are enough blood cells.
The blood loss also has an effect on the kidneys, which need a certain blood pressure to fulfil their filtering function. Therefore, blood transfusions are often necessary during the operation. Furthermore, the long period of hospitalisation in the intensive care unit can lead to further diseases.
These include pneumonia, pressure ulcers and thromboses. A late complication can be the formation of thrombi at the surgical scar, as the blood flow can be changed in the area of scars. In order to answer this question, it must first be defined whether the postoperative course, i.e. the first days and weeks after the operation, or the future life after an aortic rupture is involved.
During the first days after such an event, it is determined whether other organs were damaged during the injury. This is due to the enormous loss of blood, which is accompanied by an undersupply of blood to other organs. The brain, kidneys and intestines are particularly susceptible to this.
A simultaneous failure of several tissues, a so-called “multi-organ failure” is also possible. If the first days and weeks pass without complications, the worst is over and the patient can usually return to his former daily routine. However, a regular check-up should be carried out.
How often this is done depends on whether a minimally invasive or an open procedure was used during the operation. While a follow-up examination every 2-3 years is sufficient for open surgery, an annual check-up is required for minimally invasive surgery. Since high blood pressure is an important trigger of aortic aneurysms and thus also of ruptures, too high blood pressure should be adjusted with medication.
Blood lipids and blood sugar also have a great influence on the health and stability of the blood vessels. These should therefore also be checked regularly and if necessary corrected with medication. A dietary plan can also be helpful here, so that certain fats and sugars can be controlled without medication.