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28 Cards in this Set

  • Front
  • Back
Aneurysm: Definition
Outpouchings or dilations of the arterial wall
Occurs in men more than in women
Incidence increases with age
Aortic aneurysms may involve the aortic arch, thoracic aorta, and /or abdominal aorta
Most are found in the abdominal aorta below the level of the renal arteries
Most common etiology = atherosclerosis
Plaques deposit beneath the intima, which leads to degenerative changes in the media, which leads to loss of elasticity, weakening, and eventual dilation of the aorta.
Other Causes
Genetic predispostion
Penetration or blunt trauma
Acute or chronic infections (salmonella)
Anastomotic disruptions
Classifications (Figure 37-3)
1. True
A. Fusiform (uniform)
B. Saccular (pouch like)
2. False/Pseudoaneurysm
1. True - the wall of the artery forms the aneurysm
A. Fusiform (uniform) - goes around the circumference of the artery and is uniform in shape
B. Saccular - pouchlike with a narrow neck connecting the bulge to one side of the arterial wall
2. False/Pseudoaneurysm
Disruption of all layers of the arterial wall, which leads to bleeding that is contained by surrounding structures.
Causes: trauma, infection, peripheral graft to artery anastomosis, and arterial leakage after removal of arterial catheters or IABP
Diagnostic Studies
Physical exam
Abdominal Xray
Diagnostic Studies
Physical exam -- most diagnosed
CXR - widening of thoracic aorta
Abdominal Xray - calcification within wall of AAA and widening
Echo - aortic insufficiency related to ascending aortic dilation
Diagnostic Studies
Ultrasound - serially monitors aneurysm size
**CT - most accurate to determine anterior-to-posterior length, cross-sectional diameter, and to determine presence of thrombus
Diagnostic Studies
MRI -- used to diagnose and assess location and severity
Angiography - gives information about involvement of intestinal, renal, or distal vessels
Treatment Overview
Goal-prevent rupture of the aneurysm
Medical treatment - “watchful waiting”
Small aneurysm (<4cm)
-risk factor modification
-decrease B/P
-monitor size q6 months by CT or MRI
Surgical Repair
*Treatment of choice for:
-aneurysms >5 or 6cm, or if expanding reapidly in a asymptomatic patient
-If coexidting medical problems are stable
***Immediate Surgical Intervention if aneurysm has ruptured***
Surgical Technique
Incise diseased aorta
Remove intraluminal thrombus/plaque
Insert a synthetic (Dacron) graft
Suture native aorta around graft (protective coat)
*Surgical intervention - longer lasting, suggested for younger clients
life expectancy >20 years
Endovascular Graft Procedure (older adults)
Newest alternative
Minimally invasive
*Not suitable for aneurysms involving renal arteries
Placement of a suture less aortic graft into the abdominal aorta inside the aneurysm through the femoral artery
Dacron cylinder with multiple rings of flexible wire
Benefits to Endovascular Graft Procedure
Decreased anesthesia
Small blood loss
Decreased morbidity & mortality rates
Small bilateral groin incision
Decreased hospital stay
Decreased cost Quicker recovery
Thoracic aorta aneurysms usually asymptomatic or deep diffuse chest pain
Ascending aorta/aortic arch - hoarseness, dysphagia, distended neck veins, edema of head & arms
AAA - Abdominal aortic aneurysm (Most common) Most often asymptomatic found on routine PE or Xray for an unrelated problem or
-pulsatile mass of periumbilical area, periumbilical bruit, back pain, gastric discomfort, alt. in bowel elimination, "blue toe syndrome"
Assessment (cont)
Risk factors
Assess for signs of cardiac, pulmonary, cerebral, and LE vascular problems
Skin lesions on LE - mark & document pre-op
Character & quality of peripheral pulses - mark and assess pre-op
Complications / AAA
**Most Serious = Rupture
Manifestations: diaphoresis; paleness; weakness; tachycardia; hypotension; abdominal, back, or periumbilical pain; changes in sensorium, or a pulsating abdominal mass
Grey Turner's Sign - flank ecchymosis (bluish color across back)
**Excruciating back pain**
Normal tissue perfusion
Intact motor & sensory function
No complications related to surgical repair (thrombosis, infection)
Analysis / Diagnosis
PC: Rupture of aneurysm
Risk for ineffective tissue perfusion: peripheral/renal (*any major organ)
Risk for infection
Risk for ineffective perfusion to graft
PC: Ineffective renal perfusion
PC: Sexual Dysfunction
Decreased blood flow distal to surgery
Implementation: Watchful Waiting
-Risk factors & controls
-Manifestations of complications and what to do
-Importance of follow-up monitoring of aneurysm
Implementation: Pre-op
Monitor for rupture
Explain diagnosis, procedure, and post-op care
Establish baseline data: peripheral pulses, extremities, neck or back pain or ecchymosis
Implementation: Pre-op
Cardiopulmonary status
Renal status (BUN & Creatinine)
Neurological status
Encourage verbalization of feelings
Implementation: Post-op
Usual post-op care
Monitor graft patency
Maintain SBP
Monitor for infection
Monitor renal perfusion
Monitor GI function
Monitor perfusion distal to aneurysm (CSM, peripheral pulses)
Implementation: Home Care
Gradual increase of activities
Avoid heavy lifting for 4-6 weeks
Monitor incision for infection
Monitor color, warmth, sensation, and peripheral pulses
Antibiotics for invasive procedures or dentistry if synthetic graft in place
Sexual dysfunction may result from surgery
Alteration in peripheral vascular function
-Peripheral vascular arterial and venous disease
Current trends / Research
Ginkgo bilioba effective in increasing walking distances in patients with intermittent claudication PAD
Crestor shown to decrease existing atherosclerosis and preventing further development