Aortic rupture


A complete tear in the wall of the main artery (aorta) is called an aortic rupture. An aortic rupture occurs extremely rarely and must be treated surgically as quickly as possible, otherwise it is absolutely fatal. Even a small tear in the main artery leads to massive bleeding inside the body within a very short time. A rupture of the aorta can occur either as a result of progressive changes in the vascular wall (e.g. atherosclerosis) or as a result of blunt trauma.

root cause

A distinction is made between spontaneous aortic rupture and traumatic aortic rupture.
A spontaneous rupture can occur if the aorta is already damaged by a pre-existing aneurysm (arterial bulge) or an aortic dissection (splitting of the aorta).

The wall of the main artery consists of three layers: an inner layer of vascular cells (intima), a middle muscle layer (media) and an outer layer of connective tissue (adventitia).
In the case of an aneurysm, these three vascular layers bulge, which means that the blood vessel expands. The cause for this is often chronic damage to the vascular wall due to the deposition of arteriosclerotic plaques (arteriosclerosis) and high blood pressure (arterial hypertension). If the bulge becomes too large, the wall layers can tear completely and the aorta ruptures.
In the case of an aortic dissection, a tear results in the individual wall layers splitting and subsequent bleeding between the layers. Normally, the blood of the aorta only flows along the innermost layer, the intima. As a result of the splitting, the blood then passed between the media and adventita, the aorta expands and can tear open completely (aortic rupture).
A traumatic aortic rupture can result from blunt force applied to the chest. Most of the time, high-speed accidents (e.g. car accidents, falls from a great height or head-on collisions) lead to an impact on the chest. In such an impact, extreme shear forces act on the vessels, which can lead to the main artery rupturing.


An aortic rupture is one absolute emergencythat needs to be dealt with as soon as possible. During the physical exam, in addition to the severe chest pain, the doctor puts one Blood pressure difference stuck between arms and legs or between arms. In addition, the lack of blood supply can make the skin on the lower half of the body appear paler. Other signs are a decreased breathing noise and unconsciousness. If an aortic rupture is suspected, the diagnosis must be made immediately by imaging tests such as roentgen, Ultrasonic or Computed Tomography (CT).


Signs of a spontaneous aortic rupture may be a sudden, tearing pain be in the chest area, characteristic of being deep seated Annihilation pain is described. Depending on the location of the rupture, Blood pressure failures and neurological symptomshow loss of sensitivity and signs of paralysis occur.
The rupture of the main artery leads to massive blood loss in the chest or abdomen. The loss of blood causes a rapid drop in blood pressure, which means that the oxygen supply to the brain can no longer be guaranteed. As a result, the patient often loses consciousness and passes out. The disruption of the body's constant blood supply can also cause a Undersupply of other organs which then no longer get enough oxygenated blood and are damaged.
In the case of traumatic aortic rupture, there are usually further serious injuries to the internal organs (multiple trauma). A CT is routinely performed as part of emergency room care for polytraumatic patients. A displacement of the trachea and esophagus as well as a blurred contour of the main artery can serve as signs of an aortic rupture. Due to the heavy bleeding into the chest or abdomen, a pronounced bruise (hematoma) can be seen next to the aorta.

Concomitant symptoms

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“, Which can radiate into the back.
The rupture in the main artery leads to massive internal blood loss Circulatory instability can lead to collapse. The patients show symptoms of hemorrhagic shock. The severe loss of blood leads to a reduced blood circulation in the body, as a result blood pressure and pulse drop, of the Heartbeat accelerates (Tachycardia) and the patients have Shortness of breath (Dyspnea).
The bleeding into the abdomen causes a severe one bruise (Hematoma), which can press on the surrounding organs, causing further pain. Depending on the location, nerves can also be squeezed off, causing it to Loss of sensitivity and paralysis comes. Depending on the size of the hematoma, it can also be palpable from the outside through the abdominal wall as a pulsating knot.
A rupture of the aorta in the pericardium, which surrounds the heart from the outside as a tight connective tissue envelope, can lead to a so-called Pericardial effusion to lead. The exiting blood flows into the pericardium, which, however, is not stretchable. As a result, the heart is compressed (Pericardial tamponade) and can't hit any further. A pericardial effusion leads to cardiovascular arrest very quickly and must be treated immediately.

Loco typico - localization

The typical position of a spontaneous aortic rupture is in the abdomen (Abdomen), as this is the part of the aorta where aneurysms occur most often.
In the case of a traumatic aortic rupture, the loco typico is more than 70% of the cases on the aortic isthmus, the beginning of the descending part of the aorta from the heart in the chest cavity.


If an aortic rupture is suspected the emergency doctor must be notified immediately become. First aiders can remove restrictive clothing (necktie, scarves, or chains) and place the patient in an upright position to make breathing easier. Unconscious people should be in the stable side position be stored until the ambulance arrives.
Generally, the patient receives intensive medical treatment in the event of an aortic rupture. Essential aspects are here Oxygen supply, Intubation and artificial respiration. The vital functions, i.e. breathing, body temperature, blood pressure and pulse are constantly monitored (Monitoring). In order to compensate for the large loss of fluid, the emergency team places intravenous access through one of the fast volume delivery can be done.
When treating an aortic rupture, it is of the highest priority to get the patient to the nearest hospital as quickly as possible, where the rupture is treated as part of a Emergency surgery is supplied.


An aortic rupture must be operated on as quickly as possible, otherwise the patient will die within a very short time. There are two methods of surgical treatment of an aortic rupture: the classic direct aortic reconstruction and the endovascular stent implantation (see also: Stent). Which method the surgical team ultimately decides on depends on the size and location of the tear and the overall condition of the patient.
With the classic surgical technique, the thorax is opened on the left side 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 treating aortic rupture. In this minimally invasive treatment, a stent is advanced through the pelvic arteries to the aorta. A stent is an implant that is advanced into the vessel and serves as a replacement for the aortic wall. General anesthesia is not necessary for this procedure and local anesthesia is usually sufficient.
All major operations on the aorta and aortic arch are performed using a heart-lung machine. It 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 around 25 degrees, because cooled cells consume much less oxygen than at normal body temperature. These measures give the surgeons enough time to sew up the hole in the now bloodless aorta or to insert a prosthesis.

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Chances of survival

An aortic rupture is a fatal event for the patient and accordingly the chances of survival are very low. The mortality rate (death rate) outside the hospital is 90%.
With an acute rupture of the aorta, only about 10-15% of patients reach the hospital alive. Despite immediate emergency measures and rapid operative care, only less than half of them survive. However, due to the improved and faster diagnosis by imaging methods, the mortality rate has decreased by a few percent in recent years.
As a rule, a complete rupture of all layers of the wall of the aorta is immediately fatal. If, on the other hand, the outermost layer of connective tissue, the adventitia, remains intact, a partial aortic rupture occurs. The outer wall layer stabilizes the continuous blood flow of the aorta and the patient a chance of survival if the rupture is diagnosed and treated in a timely manner. However, there is still the risk that this layer will also tear; this is referred to as a 2-stage aortic rupture.
The probability of survival from a spontaneous aortic rupture depends heavily on how big the tear is, where it occurs, whether the rupture is immediately recognized as such and how quickly treatment is given.
In the case of traumatic aortic ruptures caused by serious accidents, the patients are usually polytraumatic. That is, they have had several serious injuries, at least one of which is life-threatening. Therefore, in such cases, the severity of the accompanying injuries largely determine the chances of survival.

What is a covered aortic rupture?

If the aortic rupture is covered, the vessel wall ruptures. The However, the tear site is covered by loops of the intestine or the peritoneumso that there is initially no massive blood loss. The blood slowly seeps from the ruptured aorta into the abdomen, causing a bruise to form on the left side. A covered aortic rupture often has no symptoms and is not recognized immediately.