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    Aortic Aneurysm

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    Janine Gerunda
    This document discusses modifiable and non-modifiable risk factors for aortic aneurysms. Modifiable factors include cigarette smoking, atherosclerosis, hypertension, obesity, and presence of a bicuspid aortic valve. Non-modifiable factors are age over 60 years old, male gender, and genetics. The document then provides information on the pathophysiology of aortic aneurysm formation, classification, etiology, manifestations, diagnostics, and treatment options which include medical management and surgical interventions like endovascular grafting.

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    Aortic Aneurysm

    Uploaded by

    Janine Gerunda
    312 views5 pages
    This document discusses modifiable and non-modifiable risk factors for aortic aneurysms. Modifiable factors include cigarette smoking, atherosclerosis, hypertension, obesity, and presence of a bicuspid aortic valve. Non-modifiable factors are age over 60 years old, male gender, and genetics. The document then provides information on the pathophysiology of aortic aneurysm formation, classification, etiology, manifestations, diagnostics, and treatment options which include medical management and surgical interventions like endovascular grafting.

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    This document discusses modifiable and non-modifiable risk factors for aortic aneurysms. Modifiable factors include cigarette smoking, atherosclerosis, hypertension, obesity, and presence of a bicuspid aortic valve. Non-modifiable factors are age over 60 years old, male gender, and genetics. The document then provides information on the pathophysiology of aortic aneurysm formation, classification, etiology, manifestations, diagnostics, and treatment options which include medical management and surgical interventions like endovascular grafting.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    312 views5 pages

    Aortic Aneurysm

    Uploaded by

    Janine Gerunda
    This document discusses modifiable and non-modifiable risk factors for aortic aneurysms. Modifiable factors include cigarette smoking, atherosclerosis, hypertension, obesity, and presence of a bicuspid aortic valve. Non-modifiable factors are age over 60 years old, male gender, and genetics. The document then provides information on the pathophysiology of aortic aneurysm formation, classification, etiology, manifestations, diagnostics, and treatment options which include medical management and surgical interventions like endovascular grafting.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    Modifiable Factors

    - Cigarette smoking
    - Atherosclerosis
    - Trauma Non – Modifiable Factors
    - Hypertension - Age (60 )
    - Arteritis - Gender (Male)
    - Obesity - Genetics
    - Presence of bicuspid aortic valve

    Accumulation of lipids, fibrin, debris, cholesterol crystals Atherosclerosis

    Plaque formation Ulcerate (brake Open) Damaged endothelial lining

    Degenerative changes Development of thrombus

    Narrows the vessel


    Loses elasticity & becomes weak

    Swept along by blood


    Dilation of Aorta

    Emboli
    Aortic Aneurysm

    An aortic aneurysm is an abnormal enlargement or bulging of the wall of the aorta.  An aneurysm can
    occur anywhere in the vascular tree.  The bulge or ballooning may be defined as a:

     Fusiform: Uniform in shape, appearing equally along an extended section and edges of the aorta.
     Saccular aneurysm: Small, lop-sided blister on one side of the aorta that forms in a weakened
    area of the aorta wall.

    History

    The first historical records about AAA are from Ancient Rome in the 2nd century AD, when Greek
    surgeon Antyllus tried to treat the AAA with proximal and distal ligature, central incision and removal of
    thrombotic material from the aneurysm.

    However, attempts to treat the AAA surgically were unsuccessful until 1923. In that year, Rudolph Matas
    (who also proposed the concept of endoaneurysmorrhaphy), performed the first successful aortic ligation
    on a human.

    Other methods that were successful in treating the AAA included wrapping the aorta with polyethene
    cellophane, which induced fibrosis and restricted the growth of the aneurysm.

    Albert Einstein was operated on by Rudolf Nissen with use of this technique in 1949, and survived five
    years after the operation. Endovascular aneurysm repair was first performed in the late 1980s and has
    been widely adopted in the subsequent decades.

    AAA is uncommon in individuals of African, Asian, and Hispanic heritage.

    There are 15,000 deaths yearly in the U.S. secondary to AAA rupture. The frequency varies strongly
    between males and females. The peak incidence is among males around 70 years of age, the prevalence
    among males over 60 years totals 2-6%.

    The frequency is much higher in smokers than in non-smokers (8:1), and the risk decreases slowly after
    smoking cessation. Other risk factors include hypertension and male sex. In the U.S., the incidence of
    AAA is 2-4% in the adult population.. AAA is 4-6 times more common in male siblings of known
    patients, with a risk of 20-30%.

    Rupture of the AAA occurs in 1-3% of men aged 65 or more, the mortality is 70-95%.
    Classification

     Thoracic aortic aneurysms are found on the thoracic aorta; these are further classified
    as ascending, aortic arch, or descendinganeurysms depending on the location on the thoracic aorta
    involved.
     Abdominal aortic aneurysms, the most common form of aortic aneurysm, are found on
    the abdominal aorta, and thoracoabdominal aortic aneurysms involve both the thoracic and
    abdominal aorta.
     Popliteal: an aneurysm in the artery behind the knee
     Renal: an aneurysm in the kidney; a very rare condition
     Visceral: an aneurysm in an internal organ and/or intestines

    Etiology
    Congenital: primary connective tissue disorders (Marfan’s syndrome, Ehlers- Danlos syndrome) and
    other diseases (focal medical agenesis, tuberous sclerosis, Turners’r syndrome, Menkes’ syndrome)

    Mechanical (hemodynamic): Poststenotic and arteriovenous fistula and amputation related.

    Traumatic (pseudoaneurysms): Penetrating arterial injuries, blunt arterial injuries

    Inflammatory (noninfectious): Associated with arteritis (Takayasu’s dse, giant cell arteritis, SLE,
    Behcet’s syndrome, Kawasaki’s dse) and periarterial inflammation (i.e pancreatitis)

    Infectious (mycotic): Bacterial, Fungal, Spirochetal infections

    Pregnancy – related degenerative: Nonspecific, inflammatory variant

    Anastomotic (postartetiotomy) and graft aneurysms: infection, arterial wall failure, suture failure,
    graft failure
    Manifestations

    Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest):

     Pain in the jaw, neck, upper back or chest


     Coughing, hoarseness or difficulty breathing, stridor, aphonia, dysphagia

    Symptoms of an abdominal aortic aneurysm (affecting lower part of aorta in abdomen):

     Pulsating enlargement or tender mass felt by a physician when performing a physical examination
     Pain in the back, abdomen, or groin not relieved with position change or pain medication

    Diagnostics

     Chest x-ray
     Computed tomography (CT) scan
     Magnetic resonance imaging (MRI)
     Echocardiography (an ultrasound of the heart) / TEE
     Abdominal ultrasound (to look for associated abdominal aneurysms)
     Angiography (an x-ray of the blood vessels)

    Treatment
    Medical

     Statin (or cholesterol lowering medication) to maintain the health of your blood vessels.

    Controlling BP (systolic pressure maintained at 100 120 mmHg)

     Antihypertensive : hydralazine (Apresoline)


     Beta – blocker : esmolol (Brevibloc), metoprolol (Lopressor)
     IV drip: Sodium nitroprusside (Nipride)
     “watchful waiting. By closely monitoring your condition with CT or MRI scans every 6-12
    months, the aneurysm will be watched for signs of changes.

    Surgical

     Endovascular graft
     Endovascular repair
     endoluminal exclusion
    Nursing Care
    1. Ineffective health maintenance
    Interventions:
    a. Assess level of client’s cognitive, emotional, physical functioning.
    b. Note clients age
    c. Note desire/ level of ability to meet health maintenance needs, as well as self-care ADLs.
    d. Assess client’s ability and desire to learn.
    e. Encourage socialization and personal involvement
    f. Assist client to develop stress management skills

    2. Fear/Anxiety related to lack of understanding of diagnostic tests, surgical


    procedure, and postoperative care.
    Interventions:
    g. Orient client to critical care unit if appropriate.
    h. Describe and explain the rationale for equipment and tubes that may present
    postoperatively. (e.g., cardiac monitor, ventilator, intravenous and intra-arterial lines,
    NGT, urinary catheter)
    i. Reinforce physician’s explanations and clarify misconceptions client has about effects of
    the surgery on sexual functioning

    3. Risk for imbalanced fluids and electrolytes


    Interventions:
    a. Note potential sources of fluid loss/intake.
    b. Note client’s age, current level of hydration, and mentation.
    c. Review laboratory data
    d. Measure and record intake and output.
    e. Weigh daily
    f. Auscultate BP, calculate pulse pressure. (pulse pressure widens before systolic BP drops
    in response to fluid loss.)

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