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28 Cards in this Set
- Front
- Back
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Aneurysm: Definition
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Outpouchings or dilations of the arterial wall
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Incidence
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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 |
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Cause/Pathology
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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. |
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Other Causes
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Genetic predispostion
Penetration or blunt trauma Acute or chronic infections (salmonella) Anastomotic disruptions |
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Classifications (Figure 37-3)
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1. True
A. Fusiform (uniform) B. Saccular (pouch like) 2. False/Pseudoaneurysm |
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1. True - the wall of the artery forms the aneurysm
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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 |
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2. False/Pseudoaneurysm
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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 |
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Diagnostic Studies
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Physical exam
CXR Abdominal Xray EKG ECHO Ultrasound CT MRI Angiography |
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Diagnostic Studies
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Physical exam -- most diagnosed
CXR - widening of thoracic aorta Abdominal Xray - calcification within wall of AAA and widening EKG - R/O MI Echo - aortic insufficiency related to ascending aortic dilation |
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Diagnostic Studies
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Ultrasound - serially monitors aneurysm size
**CT - most accurate to determine anterior-to-posterior length, cross-sectional diameter, and to determine presence of thrombus |
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Diagnostic Studies
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MRI -- used to diagnose and assess location and severity
Angiography - gives information about involvement of intestinal, renal, or distal vessels |
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Treatment Overview
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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 |
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Surgical Repair
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Indications:
*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*** |
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Surgical Technique
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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 |
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Endovascular Graft Procedure (older adults)
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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 |
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Benefits to Endovascular Graft Procedure
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Decreased anesthesia
Small blood loss Decreased morbidity & mortality rates Small bilateral groin incision Decreased hospital stay Decreased cost Quicker recovery |
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Assessment
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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" |
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Assessment (cont)
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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 |
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Complications / AAA
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**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** |
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Goals
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Normal tissue perfusion
Intact motor & sensory function No complications related to surgical repair (thrombosis, infection) |
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Analysis / Diagnosis
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Pre-operative:
PC: Rupture of aneurysm Risk for ineffective tissue perfusion: peripheral/renal (*any major organ) Post-operative Risk for infection Risk for ineffective perfusion to graft PC: Ineffective renal perfusion PC: Sexual Dysfunction Decreased blood flow distal to surgery |
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Implementation: Watchful Waiting
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Teach
-Risk factors & controls -Manifestations of complications and what to do -Importance of follow-up monitoring of aneurysm |
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Implementation: Pre-op
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Monitor for rupture
Explain diagnosis, procedure, and post-op care Establish baseline data: peripheral pulses, extremities, neck or back pain or ecchymosis |
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Implementation: Pre-op
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Cardiopulmonary status
Renal status (BUN & Creatinine) Neurological status Encourage verbalization of feelings |
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Implementation: Post-op
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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) |
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Implementation: Home Care
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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 |
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Summary
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Alteration in peripheral vascular function
-Hypertension -Peripheral vascular arterial and venous disease -Amputation -Aneurysms |
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Current trends / Research
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Ginkgo bilioba effective in increasing walking distances in patients with intermittent claudication PAD
Crestor shown to decrease existing atherosclerosis and preventing further development |
