Ruptured Giant Abdominal Aortic Aneurysm




Mahasamudram, Prathyusha
Jafferji, Fatema
Heckart, Logan
George, Kevin
Luka, Stacy
Fisher, Cara L.


0000-0003-0257-3614 (Fisher, Cara L.)

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Abstract Background: An aneurysm is commonly defined as permanent and irreversible localized dilation of a vessel. Any aneurysm located in the infradiaphragmatic aorta could be clinically known as an abdominal aortic aneurysm (AAA), but this classification is typically limited to aneurysms of the infrarenal aorta rather than suprarenal aorta. Literature varies on the exact definition of AAA, but common definitions include vessel dilation of at least 150% compared to relative normal diameter of the artery, as well when the infrarenal aortic diameter is expanded greater than 3.0 cm. The infrarenal aortic aneurysm is the most common type of AAA with a frequency of 65%, but aneurysms do occur at other locations along the aorta. AAA's are also classified by their shape as either fusiform, which are expanded circumferentially, or as saccular, which are expanded in a spherical, but more localized manner. The greater the diameter of the AAA is versus the normal diameter at the level of the renal arteries, which is approximately 2.0 cm, the greater the risk of rupture. An AAA that is greater than 8.0 cm is estimated to have a 30%-50% chance of rupture according to the Joint Council of the American Association for Vascular Surgery. Case Information: During a routine cadaveric dissection, a AAA was identified in an 86-year-old Caucasian male, whose cause of death was documented as senile degeneration of the brain. The donor was 6'0" and 186 lbs (BMI = 25.2). He had a history of heart disease and chest pains. The aneurysm was discovered after noting evidence of significant bleeding in the retroperitoneum in the form of a blood clot. The blood clot itself measured 37.55 cm in transverse diameter and 22.35 cm in height. Removal of the blood clot revealed the aneurysm, which measured 10.82 cm in transverse diameter and 11.28 cm height. Conclusion: Documentation of this case adds to the current literature and understanding of AAA's of this size. With a transverse diameter greater than 10-13 cm, the identified AAA would be classified as a giant AAA. Bleeding from the rupture of this large aneurysm involved foregut, midgut, and hindgut structures. The inferior mesenteric artery, a branch of the abdominal aorta, which supplies the distal ⅓ of the transverse colon, descending colon, sigmoid colon, and the superior rectum was the most impacted. Other nearby arteries were also affected and damaged. Furthermore, we are able to note associations between the patient's medical history and the likelihood of development and rupture of an abnormal AAA. Increased risk for AAA is associated with ethnicity, age, sex, renal cysts, smoking history, CHD, and more. Our findings indicate that close follow-up with patients with increased risk-factors for AAA would be beneficial.