Aneurysms Flashcards
What is an Aneurysm?
- An aneurysm is an abnormal localized dilation of a blood vessel
- Caused by anything that alters the integrity of the blood vessel
- ex. hypertension
- Can occur in arteries and veins, but they are most common in the aorta
What is a true aneurysm?
- A true aneurysm is one in which the aneurysm is bounded by a complete vessel wall.
- The blood in a true aneurysm remains within the vascular compartment.
- All layers of vessel wall are intact.
What is a false aneurysm?
False aneurysm or pseudoaneurysm is when blood leaks out through a tear in the artery, but it is contained by extravascular CT, forming a hematoma.
Types of Aneurysms?
- Berry
- Fusiform
- Saccular
- Dissecting
Describe a Berry Aneurysm.
- A berry aneurysm is a true aneurysm that consists of a small, spherical dilation of the vessel at a bifurcation (intersection).
- This type of aneurysm usually is found in the circle of Willis (base of the brain)
looks like a berry hanging from a stem
Describe a Fusiform Aneurysm.
- A true aneurysm that involves the entire circumference of the vessel and is characterized by a gradual and progressive dilation of the vessel.
- Vary in diameter and length
sausage shaped
Describe a Saccular Aneurysm.
A saccular aneurysm is a true aneurysm that extends over part of the circumference of the vessel and appears saclike.
Describe a Dissecting Aneurysm.
- A dissecting aneurysm is a false aneurysm resulting from a tear in the inner layer of the artery wall, which allows blood to flow between the layers of the vessel.
- blood still continues on the main highway, but some blood circulates through the back roads
- stagnant blood could lead to formation of thrombus
- Weakest type because the layers are not intact
Aortic Dissection manifestations?
- A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping.
- The location of the pain may point to the site of dissection.
- Ascending aorta - frequently located in the anterior chest
- Descending aorta - often located in the back.
Aortic Dissection manifestations related to vital signs?
In the early stages:
- Blood pressure typically is moderately or markedly elevated.
With progression:
- Blood pressure and the pulse rate become unobtainable in one or both arms as the dissection disrupts arterial flow to the arms.
Best way to obtain a pulse if patient shows signs of Aortic Dissection?
Apical pulse for a full minute
Aortic dissection treatment?
- Medical treatment focuses on the control of hypertension and the use of drugs that lessen the force of systolic blood ejection from the heart (ACEs, ARBs).
- Surgical treatment consists of resection of the involved segment of the aorta and replacement with a prosthetic graft.
Characteristics of Aneurysm manifestations?
- Depend on size and location
- An aneurysm also may be asymptomatic, with the first evidence of its presence being associated with vessel rupture.
- Unruptured aneurysms can cause damage by exerting pressure on adjacent structures and interrupting blood flow.
Thoracic aneurysm manifestations?
- Dyspnea, stridor, or brassy cough.
- Why: Pressure on the trachea.
- Hoarseness
- Why: Pressure on the laryngeal nerve
- Difficulty swallowing
- Why: Pressure on the esophagus.
- Distention of neck veins and edema of the face/neck.
- Why: Compression of the superior vena cava
- May also have substernal, back, and neck pain.
Abdominal Aortic Aneurysm manifestations?
- A pulsating mass may provide the first evidence of the disorder.
- Pain may vary from mild mid-abdominal or lumbar discomfort to severe abdominal and back pain.
- As the aneurysm expands, it may compress the lumbar nerve roots, causing lower back pain that radiates to the posterior aspects of the legs.
How would you assess for an Abdominal Aortic Aneurysm?
- Palpate
- Patient might say:
- I feel a knot in my stomach
- I feel like its beating
- Ask patient:
- Show me where the pain is
- Do you feel that the pain is moving anywhere?
Characteristics of ruptured aneurysm manifestations?
- ↑ size of aneurysm leads to ↑ risk of rupture
- vessel walls are getting weaker.
- No matter the size, there is ALWAYS the risk of rupture.
- Leads to A LOT of internal bleeding
How would you explain a CT scan to a patient?
- It uses X-rays to create images of the body
- Series of X-ray scans combined to make a 3D image
- CT tells us:
- where it is
- what kind
- true or false aneurysm
- cross-sectional diameter
How would you explain an MRI to a patient?
- It uses magnets and radio waves to produce images
- Similar to CT
- Used to diagnose issues with soft tissues that might not show up on a regular X-ray
- Can be uncomfortable for people with claustrophobia
How would you explain an angiography to a patient? What questions should you ask patients?
CT/MRI with contrast:
- Angiography with contrast will use dye to paint a map of the vasculature to help with visualization of the entire aortic system
- Requires insertion of catheter into an artery
- usually not painful, but may feel pressure
- Contrast is nephrotoxic
- Do they have CKD?
- What stage are they?
Describe Conservative Medical Therapy for small asymptomatic aneurysms.
- Risk factor modification (tobacco use, decreasing BP, optimizing lipid profile, gradual increase in activity).
- Growth rates may be lowered with beta-blockers, ACE inhibitors, ARBs, and statins.
- Patients with aneurysms smaller than 4.0 cm in diameter are usually monitored by ultrasound every 2-3 years.
Describe an Open Aneurysm Repair (OAR).
Abdominal incision where the surgeon:
- Cuts into the area where the aneurysm is
- Removes any thrombus or plaque
- Sutures a synthetic graft in place of where the diseased blood vessel was
- Sutures the aortic wall around the graft to act as a protective cover
Describe an Endovascular Aneurysm Repair (EVAR).
- Minimally invasive
- Placement of a suture-less aortic graft into the aorta and the aneurysm via the femoral artery.
- Insertion of a woven polyester tube (graft) covered by a tubular metal web stent.
- When the stent graft comes in contact with the blood vessel, it expands to the preset size
OAR and EVAR potential complications?
- Infection
- Bleeding
