[Ruptured aneurysms of the sub-renal abdominal aorta]

The rupture of an aneurysm of the sub-renal aorta may give rise to several clinical presentations which it is essential to recognise in order to carry out emergency operation, e.g. attack of pain, retroperitoneal hematoma, hemoperitoneum, rupture into a hollow viscus, infective aneurysm. The special characteristics of the treatment concern resuscitation, site and type of aortic clamping, aorto-caval or aorto-digestive rupture or an infective aneurysm raising special problems. It is the vascular collapse which makes the rupture serious, an aneurysm operated as an emergency without collapse, has a mortality which differs little from a non-ruptured aneurysm, e.g. 3 deaths out of 55 operated cases. On the other hand, out of 44 aneurysms operated in acute collapse, there were 31 deaths. The complications observed are linked to the latter, e.g. cerebro-vascular accidents, acute coronary ischemia, acute ishemia of the limbs, which may also be due to embolism during operation, renal complications due to renal shock. The prevention of these complications has permitted us to reduce mortality by 40 p. 100 the last 5 years.