Challenges in diagnosis and surgical management of rare forms of abdominal aortic aneurysm rupture
AbstractBackground. Abdominal aortic aneurysms (AAA) occupy the first place by the incidence amongst all aortic aneurysms and are found in 0.1–1.6% of all autopsies. The natural outcome of the AAA course is rupture occurring, according to literature data, in 50–80% of patients Amongst AAAs, there are forms posing great challenges in diagnosis and surgical management due to rarity of the disease and diversity of clinical manifestations.
Objective. The purpose of this study was to determine the leading clinical signs of rare forms of AAA rupture and develop optimal surgical tactics of treating them.
Patients and methods. At the Department of Vascular Surgery of the “Institute of Emergency and Restorative Surgery named after V.K. Gusak”, we operated on a total of 633 patients with AAAs, of these, 285 (45%) for a ruptured aneurysm. Amongst the latter, there were 22 (7.7%) patients presenting with rare forms of rupture defined as: chronic contained rupture in 7 (2.5%) patients, aneurysmal rupture into the gastrointestinal tract with the formation of an aortoenteric fistula in 6 (2.1%) patients, rupture into the inferior vena cava with the formation of an aortocaval fistula in 6 (2.1%) patients, and a combination of AAA rupture with abdominal aortic dissection in 3 (1%) cases. The main methods of examination included duplex and triplex scanning, Doppler ultrasonography, and in insufficient information, spiral computed tomography (SCT) and SCT-angiography.
Results. All 22 patients were operated on. Of these, 9 (40.9%) patients died. The diagnostic peculiarities were as follows: 1. Chronic contained rupture turned out to be difficult to differentiate from a retroperitoneal tumor, both before and during surgery. Two-phase nature of clinical manifestations was characteristic of the clinical course of this variant of rupture. 2. Aortoenteric fistulas were characterized by symptoms of a pulsatile mass in the abdominal cavity, relapsing gastrointestinal bleeding, with negative results of fibrogastroduodenoscopy. 3. Aortocaval fistulas were characterized by systolic-diastolic murmur above the aneurysm and acute right ventricular cardiovascular insufficiency.
Conclusion. Diagnosis of rare forms of AAA rupture is a difficult task, the clinical course of the disease is characterized by a wide variety of symptoms, thus leading to delayed rendering of emergency specialized care. Surgical tactics in rare forms of abdominal aneurysm rupture has not yet been standardized and solving this problem requires further accumulation of experience.
Keywords: chronic contained rupture; aortoenteric fistula; aortocaval fistula; aortic dissection
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Ivanenko A.A.; data collection and handling – Popivnenko F.S., Glebova A.E.; operative treatment and patient management – Ivanenko A.A., Popivnenko F.S., Konyashin A.A.; draft manuscript preparation – Ivanenko A.A.; manuscript revision – Ishchenko R.V., Filimonov D.A.
For citation: Ivanenko A.A., Ishchenko R.V., Filimonov D.A., Popivnenko F.S., Konyashin A.A., Glebova A.E. Challenges in diagnosis and surgical management of rare forms of abdominal aortic aneurysm rupture. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (1): 104–12. DOI: https://doi.org/10.33029/1027-6661-2026-32-1-104-112
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