19/01/2025
Life After Ruptured Aneurysm (LARA)
This webpage explains what a ruptured aortic aneurysm is, how it can be repaired, the risks of the condition and links to patient and family support groups.
What is an aortic aneurysm?
An aneurysm is a ballooning of a high pressure blood vessel (artery) that takes blood from the heart to the rest of the body. The main artery in the body is the aorta and runs through the chest (thoracic aorta) and belly (abdominal aorta). It divides into right and left leg arteries at the level of the belly button.
Aneurysms grow over years but when they reach a large size, they can burst, leading to major bleeding into the chest or abdomen. A normal aorta is about 3cm in the chest and 2cm in the belly.
Aortic aneurysms can be:
Thoracic (in the chest)
Abdominal (in the belly)
Thoracoabdominal (in the chest and belly)
They can occur by chance, be inherited, or occur from other processes such as a tear in the wall of the aorta (aortic dissection).
What happens in a rupture?
Typically a person develops sudden backache, chest pain or belly pain and may collapse and look grey and sweaty. This is because they are bleeding internally. Often this bleeding may stop briefly, due to the body’s clotting mechanism (herald bleed). Typically the next episode of bleeding will be much more severe and in some cases, fatal.
About 500 people in the UK have a ruptured aneurysm each year (about 2 every day). Because of this we have introduced a screening programme for men aged 65 years with a single ultrasound.
How can a ruptured aortic aneurysm be diagnosed?
Your doctor will request a CT scan to map out the aortic aneurysm, see whether it has ruptured and how it may be repaired.
How are aortic aneurysms repaired?
Depending on what the aneurysm looks like on the scan it may be suitable for:
1. Stenting
2. Open surgery
3. Neither
In the stenting procedure, the groin arteries are punctured and a guide wire introduced up into the aorta. Over this wire, a fabric coated stent (tube) is introduced which covers the hole in the aorta from the inside, like a puncture repair. The fabric is waterproof so blood cannot leak out through the hole any more. Sometime extra procedures are necessary to deal with branch blood vessels, such as plugging them. Occasionally an open bypass procedure will be needed to restore flow to a blocked artery. These extra procedures increase the complexity and time needed to perform the procedure. Stenting can be performed awake or asleep.
An average stenting procedure may take about 2 hours, if they are straightforward.
In the open surgery procedure a cut is made in the abdomen with the patient asleep. Clamps are placed on the top and bottom of the aorta to stop bleeding. The diseased section is replaced with a polyester tube which is hand sewn into the healthy aorta above and below the aneurysm.
This is a difficult surgery and may take about 4 hours.
Some aortic aneurysms are inoperable because of the complexity of the procedure, if the patient is frail or if the patient’s heart is failing from lack of blood flow (cardiac arrest). In this case the doctor will inform the next of kin and ensure that the patient receives strong painkillers and has a chance to see or talk to their family. It can take minutes, hours or days for this process and it is unpredictable. Patients are usually managed on the vascular ward during this time in a side room. This is generally non-survivable.
What can I expect after surgery?
The best place to meet the operative team is the relatives room on Critical Care Unit (Level A main building).
Patients will be extremely sick and will be on intensive care. They may be kept in a coma overnight until they have recovered enough to breath for themselves again. They may require support for their lungs, kidneys and blood transfusions (sometimes their own blood can be recycled during the operation).
People can take weeks to recover in hospital after open surgery, but with stenting it is usually about one week. Some people need to go back to theatre for further procedures, for example if the blood supply to their bowel or spinal cord is compromised.
What are the risks of surgery?
Upto 10% of people die in the theatre itself from major bleeding.
Between 20-50% of people die in hospital from heart attack, loss of blood supply to the gut, or lung disease.
Between 10-20% of people return to the operating theatre for a further procedure, e.g. closing an open abdominal wound, removal of clot from a major artery, excision of dead bowel, or a major amputation.
What is life like if you get home?
People take around 2-3 months to recover from this life event and may experience tearfulness, loss of energy and flashbacks. This is the most traumatic emergency surgery and it can help survivors to meet other survivors via the MSE trust’s LARA (life after ruptured aneurysm) network.
If you have had a stenting procedure you will need annual check scans to monitor the stents. About 1 in 5 people during their lifetime may need a further procedure if their stents develop a problem (e.g. the aneurysm keeps growing, or the stent dislodges or blocks).
What can I do if my loved one does not make it?
This is a traumatic experience for both the healthcare staff and the family.
Do NOT drive home after receiving bad news – please ask someone to drop you at home.
It is very common to think of questions later on, so please ask for your consultant’s secretary’s email, and book in after 6 weeks to discuss any questions you may have, even on the telephone.
If you have children, please advise them to attend abdominal aortic aneurysm screening aged 65 – men are automatically invited, but women with a family history can self-refer.
Finally, when you feel ready please contact the LARA support officer, which can put you in touch with other families who have made this difficult journey and who can offer practical advice. LARA also signposts to our bereavement counselling service.
LARA support first contact point: Karen Strong (karen.strong3@nhs.net)
MSE bereavement nurses Kim, Laura and Sophie: mse.bereavementnurses@nhs.net
Hospital chaplains: MSE.basildonchaplains@nhs.net
