[Ruptures of abdominal aortic aneurysms. The clinical course and classification]

Surgical treatment of abdominal aortic aneurysm (AAA) ruptures is a matter of great concern in current vascular surgery. The results of surgical treatment of patients presenting with such severe disease could have been improved due to the early and correct diagnosis. The present work is concerned with a study into the characteristic features and causes of the atypical clinical manifestations and the course of AAA ruptures as well as with the development of the classification accessible for practical uses. Later on it would allow to refine the treatment policy for an extremely severe patient group and to define a permissible algorithm of examination in the postoperative time and would favour the early diagnosis of disease. The study is based on an analysis of the clinical course of AAA rupture in 53 patients operated on at the Department of Vascular Surgery. MONIKI. The clinical manifestations were typical in 46 (86.8%) patients. The progressing course of AAA rupture was observed in 21 (39.6%) patients; the disease ran a wave-like course in 17 (32.1%) patients. Stabilization of the condition was marked in 15 (28.3%) cases. In 39 (73.6%) cases, AAA rupture affected the retro-peritoneal space, the free abdominal cavity was affected in 8 (15.1%), the duodenum in 2 (3.8%), the sigmoid intestine in 2 (3.8%), and the inferior vena cava in 2 (3.8%) of cases. The rupture of the posterior wall of the aortic aneurysm was identified in 29 (54.7%), of the lateral wall in 12 (22.6%), and of the anterior wall in 8 (15.1%) patients. Four (7.5%) patients demonstrated aneurysmal rupture of the iliac artery. The clinical manifestations of AAA rupture were marked by polymorphism whereas its course was often masked by other diseases making it difficult to establish the early and correct diagnosis. The difficulties in the diagnosis of AAA ruptures gave rise to a lot of diagnostic errors and late hospitalization to specialized unita.