Ruptured abdominal aortic aneurysm
Severe right back pain; haemoglobin = 8.
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An 8 cm juxtarenal abdominal aortic aneurysm is noted. Blood is noted along the right side of the aneurysm extending around Gerota's fascia. The renal arteries arise from the aneurysm.
Abdominal aortic aneurysms (AAA) are most commonly from atherosclerotic disease and occur in over 5% of the US population over 60 years of age. Smoking, hypertension and connective tissue disorders are among the risk factors. Men are affected more frequently than women. Only 20% of the cases present with a rupture. Most are detected incidentally. Mortality from rupture approaches 90% with involvement of the renal arteries particularly ominous.
Generally AAA over 5 cm in size are electively repaired, either surgically or by endograft placement. The risk of rupture for a 5 cm aneurysm over the following year is 6-7% compared to the 3-5% morbidity and mortality from surgery. Endograft placement in selected patients appears to have lower morbidity and mortality than surgical repair.