Morphology of ruptured abdominal aortic aneurysms

Objectives: it has been suspected that the position at which aneurysm ruptu re occurs would affect outcome. The nim of this prospective study teas to r elate the morphology of the ruptured abdominal aortic aneurysm (RAAA) to th e clinical characteristics and outcome of the patient. Design, patients and methods: over a five-year period 46 patients with RAAA s (11 identified at operation and 35 at post-mortem (PM)) were examined to identify the number and site of aneurysm rupture, the characteristics of th e aneurysm (site, shape, length, diameter and associated iliac aneurysm) an d the presence and site of retroperitoneal nl or intraperitoneal haematoma. The patients were also assessed for a range of associated medical conditio ns. Univariate analysis tons used to identify variables predicting the site of aneurysm rupture and survival following rupture. Results: most aneurysm ruptures (73%) occurred in the middle third where th e aneurysm diameter was greatest. Relatively few ruptures (13%) were in the left posterior quadrant of the aneurysm. A history of chronic lung disease (p = 0.04) significantly predicted the quadrant of aneurysm rupture, while a history of carcinoma (p = 0.02) predicted the level of rupture. Nine of the 46 (20%) patients survived. Survival was predicted by the transverse si te of rupture (p = 0.0004) and the absence of ischaemic heart disease (p = 0.02). Conclusion: these data suggest that the site of aneurysm rupture, which may be in part predicted by the clinical characteristics of the patient, influ ences outcome.