{{Short description|Breakage of the aorta}} {{Distinguish|aortic dissection}} {{Infobox medical condition | name = | synonym = | image = Aorta segments.svg | image_size = 300px | alt = | caption = Aorta segments, with thoracic aorta in area marked in green. | pronounce = | specialty = Vascular surgery, cardiology, emergency medicine | symptoms = Abdominal pain, flank pain, or back pain | complications = Shock, anemia | onset = Acute | duration = | types = | causes = Ruptured aortic aneurysm, trauma | risks = | diagnosis = | differential = | prevention = | treatment = Surgical repair | medication = | prognosis = Poor | frequency = | deaths = Up to 90% of cases }}

'''Aortic rupture''' is the breakage of all walls of the aorta, the largest artery in the body. Aortic rupture is a rare, extremely dangerous condition that is considered a medical emergency.<ref name=":0" /> The most common cause is an abdominal aortic aneurysm that has ruptured spontaneously. Aortic rupture is distinct from aortic dissection, which is a tear through the inner wall of the aorta that can block the flow of blood through the aorta to the heart or abdominal organs.

An aortic rupture can be classified according to its cause into one of the following main types: * Traumatic aortic rupture * Aortic rupture secondary to an aortic aneurysm<ref>[http://www.patient.co.uk/doctor/Ruptured-Aortic-Aneurysm.htm Ruptured Aortic Aneurysm] at Patient UK. Original Author: Laurence Knott. Current Version: Gurvinder Rull. Peer Reviewer: Hannah Gronow. Last Checked: 16/05/2012</ref>

==Signs and symptoms== Patients with an aortic rupture typically present with a sudden onset of severe pain. In ruptures involving the thoracic aorta, patients often experience acute chest pain that may radiate to the back, whereas involvement of the abdominal aorta more frequently results in pain localized to the abdomen, flank, or lower back. The rapid blood loss can lead to signs of shock, such as low blood pressure, rapid heartbeat, pallor, and even loss of consciousness. Because the clinical presentation may overlap with other vascular emergencies such as Aortic dissection—timely diagnosis using imaging modalities (e.g., computed tomography) is critical to initiate appropriate management.<ref>Jeanmonod, D., Yelamanchili, V. S., & Jeanmonod, R. (2024). Abdominal Aortic Aneurysm Rupture. In StatPearls. StatPearls Publishing.</ref>

==Causes== Aortic rupture may result from several distinct etiologies. The most common mechanism involves the spontaneous rupture of an aneurysmal aorta; for example, weakening of the vessel wall due to an Abdominal aortic aneurysm or Thoracic aortic aneurysm can ultimately lead to rupture under elevated intraluminal pressure. In addition, aortic rupture may occur following blunt trauma, as seen in Traumatic aortic rupture, where high-energy impacts from vehicle collisions or significant falls produce differential deceleration forces that tear the aortic wall. On rare occasions, iatrogenic injury during medical or surgical procedures can also precipitate aortic rupture.<ref name=":1" />

==Mechanism== {{Empty section|date=July 2024}}

==Diagnosis== {{Expand section|date=October 2024}} Diagnosis of a ruptured abdominal aortic aneurysm (rAAA) is challenging, with a wrong diagnosis occurring in between 32 and 42 % of cases. Such errors further increase the mortality risk due to incorrect first response and treatment. In cases of misdiagnosis, aortic rupture is often mistaken for ureteric colic and myocardial infarction (MI).<ref name=":1">{{Cite journal |last1=Azhar |first1=Bilal |last2=Patel |first2=Shaneel R. |last3=Holt |first3=Peter J.E. |last4=Hinchliffe |first4=Robert J. |last5=Thompson |first5=Matt M. |last6=Karthikesalingam |first6=Alan |date=August 2014 |title=Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis |url=http://jet.sagepub.com/lookup/doi/10.1583/13-4626MR.1 |journal=Journal of Endovascular Therapy |language=en |volume=21 |issue=4 |pages=568–575 |doi=10.1583/13-4626MR.1 |pmid=25101588 |issn=1526-6028|url-access=subscription }}</ref>

=== Differential diagnosis === The primary differential diagnoses include cardiogenic shock, pleural effusion, pulmonary embolism, myocarditis, myocardial infarction,<ref>{{Cite web |title=Aortic Dissection Differential Diagnoses |url=https://emedicine.medscape.com/article/2062452-differential?form=fpf |access-date=2024-10-25 |website=emedicine.medscape.com}}</ref> but may also encompass acute gastritis, appendicitis, diverticulitis, gallstones, peptic ulcer disease and urinary tract infection as well.<ref name=":0">{{Citation |last1=Jeanmonod |first1=Donald |title=Abdominal Aortic Aneurysm Rupture |date=2024 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK459176/ |access-date=2024-10-25 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29083705 |last2=Yelamanchili |first2=Varun S. |last3=Jeanmonod |first3=Rebecca}}</ref>

==Prevention== {{Further|Aortic aneurysms#Prevention}}This involves 2 main strategies: managing lifestyle risks (to prevent an aneurysm from forming or growing, and medical screening to catch potential issues before they become emergent.<ref name=":2">{{Cite web |title=Abdominal aortic aneurysm - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/symptoms-causes/syc-20350688 |access-date=2025-12-17 |website=Mayo Clinic |language=en}}</ref><ref name=":3">{{Cite web |title=What Is Aortic Dissection? |url=https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection |archive-url=http://web.archive.org/web/20250918112429/https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection |archive-date=2025-09-18 |access-date=2025-12-17 |website=Cleveland Clinic |language=en}}</ref><ref>{{Cite web |title=Preventing Aortic Dissection |url=https://nyulangone.org/conditions/aortic-dissection/prevention |access-date=2025-12-17 |website=nyulangone.org |language=en}}</ref>

Lifestyle risks include:

* Smoking, tobacco use is the single strongest risk factor for aortic rupture.<ref name=":2" /> * Blood pressure management: Hypertension is a significant risk factor.<ref name=":3" /> * Weightlifting Caution, extremely heavy and strained weightlifting can trigger a rupture in a weakened aorta.<ref>{{Cite web |title=Aortic dissection-Aortic dissection - Symptoms & causes |url=https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496 |access-date=2025-12-17 |website=Mayo Clinic |language=en}}</ref> * Seatbelt safety<ref>{{Cite web |title=Preventing Aortic Dissection |url=https://nyulangone.org/conditions/aortic-dissection/prevention |access-date=2025-12-17 |website=nyulangone.org |language=en}}</ref> Who should be screened?

* People aged 65-75 who have ever smoked<ref>{{Cite web |date=2025-11-04 |title=Abdominal Aneurysm Screening Guidelines: 8 Essential Points for 2025 |url=https://int.livhospital.com/abdominal-aneurysm-screening-guidelines-8-essential-points-for-2025/ |access-date=2025-12-17 |language=en-US}}</ref> * People with a family history (especially if it's a first-degree relative)<ref>{{Cite web |date=2025-12-11 |title=10 Tips to Help Reduce Your Risk of an Aortic Aneurysm This Valentine’s Day |url=https://www.bangkokhospital.com/en/bangkok-heart/content/10-tips-to-help-reduce-your-risk-of-an-aortic-aneurysm-this-valentines-day |access-date=2025-12-17 |website=Bangkok Heart Hospital |language=en}}</ref> * People with genetic factors: such as Marfan Syndrome, Ehlers-Danlos, or having a bicuspid aortic valve.<ref>{{Cite web |title=Aortic Dissection |url=https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection#:~:text=Aortic%20aneurysm%20(an%20abnormal%20enlargement,syndrome%20and%20Ehlers%2DDanlos%20syndrome. |access-date=17 December 2025 |website=Cleveland Clinic}}</ref> Medical interventions:

* Aspirin and Statins: manage cholesterol and prevent atherosclerosis (hardening of the arteries) which can lead to many aortic issues.<ref>{{Cite web |title=Living With Aortic Aneurysm {{!}} Mass General Brigham |url=https://www.massgeneralbrigham.org/en/about/newsroom/articles/living-with-aortic-aneurysm#:~:text=Medication%20can%20help%20improve%20your,help%20control%20your%20cholesterol%20levels |access-date=2025-12-18 |website=www.massgeneralbrigham.org}}</ref> * Beta-Blockers: these can slow the heart rate and reduce the impact force on the aortic wall.<ref>{{Citation |last=Levy |first=David |title=Aortic Dissection |date=2025 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK441963/ |access-date=2025-12-18 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28722992 |last2=Sharma |first2=Sanjeev |last3=Farci |first3=Fabiola |last4=Le |first4=Jacqueline K.}}</ref>

==Treatment== Treatments range according to the severity of the condition from monitoring to emergency surgical repair.<ref name=":4">{{Cite web |title=Thoracic aortic aneurysm - Diagnosis and treatment - Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/diagnosis-treatment/drc-20350193#:~:text=Stop%20the%20aneurysm%20from%20growing,Patient%20consult |access-date=2025-12-18 |website=www.mayoclinic.org |language=en}}</ref> Treatments include:

* Monitoring * Medication * Surgery ** Endovascular Aortic Repair (EVAR/TEVAR)<ref>{{Cite web |title=Endovascular Repair of an Abdominal Aortic Aneurysm |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/abdominal-aortic-aneurysm/endovascular-repair-of-an-abdominal-aortic-aneurysm#:~:text=Endovascular%20repair%20is%20a%20minimally,an%20artery%20in%20your%20groin. |access-date=18 December 2025 |website=Johns Hopkins Medicine}}</ref> ** Open-Surgical Repair<ref>{{Cite journal |last=Sidik |first=Abubakar I. |last2=Dontsov |first2=Vladislav V. |last3=Khavandeev |first3=Maxim L. |last4=Esion |first4=Grigorii A. |last5=Karpenko |first5=Ivan G. |last6=Sobolev |first6=Dmitriy |last7=Hossain |first7=Limon |last8=Ilyas Shafii |first8=Abdulmajid |last9=Derrar |first9=Ahlam |last10=Najneen |first10=Farjana |last11=Ak |first11=Gulten |last12=Ghosh |first12=Debraj |last13=Parera |first13=Oralee Bonifacio |date=2025-10-06 |title=Open vs. Endovascular Aortic Repair: Guidelines and Real-World Outcomes |url=https://doi.org/10.33678/cor.2025.065 |journal=Cor et Vasa |language=en |volume=67 |issue=4 |pages=493–504 |doi=10.33678/cor.2025.065|doi-access=free }}</ref> * Emergent treatment ** Blood Pressure Control with IV medications to drop blood pressure to the lowest safety level.<ref>{{Cite journal |last=Isselbacher |first=Eric M. |last2=Preventza |first2=Ourania |last3=Hamilton Black |first3=James |last4=Augoustides |first4=John G. |last5=Beck |first5=Adam W. |last6=Bolen |first6=Michael A. |last7=Braverman |first7=Alan C. |last8=Bray |first8=Bruce E. |last9=Brown-Zimmerman |first9=Maya M. |last10=Chen |first10=Edward P. |last11=Collins |first11=Tyrone J. |last12=DeAnda |first12=Abe |last13=Fanola |first13=Christina L. |last14=Girardi |first14=Leonard N. |last15=Hicks |first15=Caitlin W. |date=2022-12-13 |title=2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines |url=https://pubmed.ncbi.nlm.nih.gov/36322642 |journal=Circulation |volume=146 |issue=24 |pages=e334–e482 |doi=10.1161/CIR.0000000000001106 |issn=1524-4539 |pmc=9876736 |pmid=36322642}}</ref> ** Emergency surgery: An emergency EVAR or open repair.<ref>{{Cite web |title=Thoracic aortic aneurysm - Diagnosis and treatment - Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/thoracic-aortic-aneurysm/diagnosis-treatment/drc-20350193 |access-date=2025-12-18 |website=www.mayoclinic.org |language=en}}</ref>

==Prognosis== An aortic rupture is a catastrophic medical emergency. People rarely survive such an injury. Mortality from aortic rupture is up to 90%. 65–75% of patients die before they arrive at the hospital and up to 90% die before they reach the operating room.<ref>{{cite journal|last1=Brown|first1=LC|last2=Powell|first2=JT|title=Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.|journal=Annals of Surgery|date=September 1999|volume=230|issue=3|pages=289-96; discussion 296-7|pmid=10493476|doi=10.1097/00000658-199909000-00002|pmc=1420874}}</ref> In non-emergent cases the survival rate is over 95%, for an emergent ruptured aorta it is between 50-70%.<ref name=":4" />

==References== {{Reflist}}

{{Vascular diseases}} {{Authority control}}

Category:Diseases of the aorta