Table 1 : Abdominal Aortic Aneurysm parameters and severity score . Adapted after Chaikof 2002 [ 2 ]
Attribute
Absent Score of 0
Mild Score of 1 Aortic Neck
Moderate Score of 2
Severe Score of 3
Length ( mm ) > 25 15 – 25 10 – 15 < 10 Diameter ( mm ) < 24 24 – 26 24 – 28 > 28 Angle ( degrees ) > 150 150 – 135 120 – 135 < 120
Calcification of Thrombus (%)
0 < 25 25 – 50 > 50
Aortic Aneurysm Aortic tortuosity index < 1.05 1.05 – 1.15 1.15 – 1.2 > 1.2 Aortic angle ( degrees ) 160 – 180 140 – 159 120 – 139 < 120 Thrombus (%) 0 < 25 25 – 50 > 50
Aortic branch vessels |
No vessels |
1 branch : lumbar |
|
|
or inferior |
|
|
mesenteric artery |
Pelvic Perfusion
Patent bilateral internal iliac arteries
Single internal iliac artery occlusion
Iliac Artery
Calcification |
none |
< 25 % of vessel |
|
|
length |
Diameter / Occlusive disease
> 10mm no occlusive disease
8 – 10 mm No stenosis < 7mm in diameter or > 3cm in length
At least 2 vessels All < 4mm diameter
Single internal iliac artery occlusion and contralateral internal iliac stenosis > 50 %
25 – 50 % of vessel length
7 – 8 mm Focal stenosis < 7mm in diameter and < 3cm in length
At least 2 vessels with diameter > 4mm
Bilateral internal iliac arteries occlusion
> 50 % of vessel length
< 7 mm Stenosis < 7mm in diameter and > 3 cm in length More than one focal stenosis < 7mm in diameter
Iliac artery tortuosity index < 1.25 1.25 – 1.5 1.5 – 1.6 > 1.6 Iliac artery angle ( degrees ) 160 – 180 121 – 159 90 – 120 < 90
Common iliac artery length ( mm )
> 30 20 – 30 10 – 20 < 10
Iliac artery diameter ( mm ) < 12.5 12.5 – 14.5 14.5 – 17 > 17
GROSS ANATOMICAL FINDINGS
The left retroperitoneal space was filled with extensive organized hematoma that covered the Gerota ’ s fascia and the psoas muscle . The hematoma extended along the spermatic cord into the left inguinal canal all the way down to the scrotum . The point of rupture was identified on the left posterolateral wall of the aneurysm . To note , the patient ' s left flank showed a characteristic ecchymosis consistent with Grey Turner ’ s sign of a retroperitoneal bleed ( David et al ., 2012 ) These findings are suggestive of a retroperitoneal haemorrhage from a ruptured AAA which likely led to sudden death due to exsanguinating haemorrhage .
AORTIC NECK
This aneurysm had a proximal aortic neck length ( distance from the left -lowest- renal artery to the top of the aortic aneurysm ) of 5 mm , which classifies it as a juxtarenal AAA ( severe , score of 3 ) [ Figure 1 ]. The aortic neck diameter was 24mm ( mild , score of 1 ). The aortic neck was not calcified ( absent , score of 0 ).