Clinical Features and Prognosis of Dissecting Aneurysms and Ruptured Saccular Aneurysms

¹ Senior Medical Registrar, Registrar, Royal Infirmary, Sheffield, England

Following the onset of dissecting aneurysms and repture of saccular aneurysms, > 50 percent of patients were dead within 24 hours, with a longer late survival for ruptured saccular aneurysms. Any assessment of the efficacy of treatment must take the duration of the rupture or dissection into consideration. The majority of these patients die suddenly (ie, in the community), and these cases probably account for at least 5 percent of sudden nonviolent deaths. There was a characteristic clinical picture in the survivors which enabled the site or origin of the dissection or aneurysmal rupture to be determined. Dissecting aneurysms originating proximal to the innominate artery, produced central chest pain which rarely radiated to the back, were often associated with hypotension and were usually terminated by cardiac tamponade. Dissecting aneurysms originating distal to the innominate artery often produced abdominal (±) chest pain, radiating to the back and usually were associated with a hemothorax. Chest radiography usually demonstrated progressive aortic dilatation in both forms of dissecting aneurysm. Ruptured saccular aneurysms were predominantly abdominal and produced abdominal pain radiating to the back. A tender abdominal mass was occasionally found. Thoracic saccular aneurysms usually presented with chest (±) back pain, and hemoptysis was only a terminal feature.