aneurysms Flashcards
(27 cards)
aneurysms
. Abnormal dilation in a portion of the
arterial wall. Caused by weakness in medial ( muscle ) layer of vessel. Intima & adventitia then stretch.
b. Creates high arterial wall tension in
area of aneurysm. Can burst, causing hemorrhage.
saccular aneurysm
•bubble in portion of arterial wall
fusiform aneurysms
•dilation entirely encircles a portion
of the arterial wall
dissecting aneurysm
•blood separates layers of arterial
wall. Blood is lost & blood flow
to organs is diminished.
more common in thoracic area than abdominal area
false aneurysm
•rupture of an artery but blood collects
next to vessel. Occur as result of
vessel injury or trauma.
worst aneurysm is
dissecting
aortic aneurysm
•May involve aortic arch, thoracic aorta and
abdominal aorta.
abdominal aortic aneurysms
•arise between
renal and iliac arteries.
thoracic aortic aneurysms
•arise between
subclavian and renal arteries.
Thoracic aortic aneurysm
•Not as common as AAA. Most frequently
in men between 40-70 years old.
•Most common site for dissection. Often
misdiagnosed. 1/3 die from rupture.
- Most caused by atherosclerosis & hypertension.
- Other causes are trauma, coarctation of aorta,and Marfan’s Syndrome.
dissecting thoracic aortic aneurysm
•Considered life-threatening emergency caused by tear in intima of aorta with hemorrhage into media. Splits vessel wall forming blood filled channel between its layers.
hypertension is major predisposing risk factor
Type A dissecting thoracic aorta aneurysm
•called proximal dissection. Affects ascending aorta.
Type B dissecting thoracic aortic aneurysm
•Distal dissection limited to descending aorta.
symptoms of dissecting aortic aneurysm
- Severe anterior chest pain or intrascapular pain radiating down spine into abdomen and legs. May be in neck, jaw, and teeth.
- Pain is described as tearing or ripping and boring.
- If in the aortic arch, may see changes in levels of consciousness, dizziness, and weakened or absent carotid and temporal pulses.
- Superficial veins in chest, neck, arms may be dilated and edema and cyanosis may be seen.
- Diaphoresis, nausea, and vomiting, fainting, and apprehension are also common.
- Blood pressure changes, decrease or absent peripheral pulses may be seen.
- Complications: rupture and hemorrhage
abdominal aortic aneurysm
- Most common cause is atherosclerosis.
- Affects men 4xs more than women. Prevalent in the elderly.
- 2/3 people are symptomatic.
- Most occur below renal arteries, usually at branch of iliac arteries.
- Associated with hypertension, increased age, and smoking. Most people over 70 years.
symptoms of abdominal aortic aneurysm
- May see pulsatile mass in periumbilical area, slightly left of midline.
- Bruits may be heard.
- Feeling like there is a heart beat in the abdomen.
- When pain is present, may be constant or intermittent. Usually is mid abdominal area or lower back. Severe pain usually indicates impending rupture.
- Can cause “blue toe syndrome” with patchy mottling of feet and toes in the presence of pedal pulses.
- Sluggish blood flow to small vessels can cause thrombi and embolization.
- Complication: rupture and hemorrhage. Up to 50% patients die from rupture before hospitalization. Only 10 to20% survive.
rupture of abdominal aortic aneurysm
- If posterior rupture into retroperitoneal space, bleeding may be tamponaded by surrounding structure, preventing exsanquination.
- Have severe back pain and may or may not have back and flank ecchymosis ( Turner’ssign ).
- If rupture is anterior into abdominal cavity, death from exsanquination is likely.
- If the person survives can have ischemia or infarct to myocardium, kidneys and bowels. Paraplegia is rare.
assessment/ diagnostic of thoracic aneurysm
If large veins in chest compressed, superficial veins in chest, neck, arms may be dilated and edematous. Cyanosis may be seen.
b. Pressure against cervical sympathetic chain can cause unequal pupils.
c. Diagnosis by chest Xray, MRI, CT, transesophageal echocardiogram (TEE)
assessment/diagnostic of abdominal aneurysm
a. Pulsatile mass, systolic bruit
b. Diagnosis by ultrasound, CT. If it is too small for surgery, have ultrasounds every six months to monitor status.
c. Aortagraphy via femoral artery can be used to anatomically map the system with contrast dye. Can be nephrotoxic.
management of an aneurysm
very important to keep systolic BP low
•Control SB/P to 100 to 120 with antihypertensives. Correct risk factors like smoking.
surgery for aneurysm
Symptomatic & expanding anerysm
b. Thoracic more than 6cm. Abdominal
more than 5cm.
c. Dissecting:
1. Type A- ASAP
2. Type B- depends on involvement & possibility
of rupture.
d. Can be open surgery or endovascular surgery.
benefits of endocascular repair
- Decreased anesthesia and operative time.
- Smaller blood loss.
- Decreased morbidity & mortality.
- Small bilateral groin incisions.
- More rapid resumption of physical activity.
- Shortened hospital time. Reduced costs.
- Quicker recovery.
- Higher patient satisfaction.
potential complications of an endocascular repair
- Has higher reintervention risk.
- Aneurysm growth & rupture.
- Perigraft leaks. Most common problem
- Aortic dissection
- Bleeding, graft dislocation, embolization, renal artery occlusion due to graft migration, graft thrombosis, incisional hematoma & infection.
nursing pre-op care for endovascular approach
- Patient may be hydrated. Electrolyte, coagulation, hgb & hct abnormalities corrected.
- VS, cardiopulmonary, vascular and neurovascular baseline assessment.
- Assess patient’s level of understanding of surgery
- Pre-op teaching
- Assess other risk factors with surgery
- Orientation to ICU if open surgery
- NPO, pre-op antibiotics
