Aortic Aneurysm & Aortic Dissection Flashcards
Aortic aneurysm
Outpouching or dilatation of the aorta
Causes of Aortic Aneursym
- Degenerative
- Congenitial problems (Marfan’s)
- Mechanical (penetrating or blunt trauma)
- Inflammatory (aortitis)
- Infectious (HIV)
Risk factors
Age, male gender, hypertension, CAD, family history, tobacco use, hyperlipidemia, PAD lower extremities, carotid artery disease, previous stroke, obesity
Locations
- Ascending aorta
- Aortic arch
- Thoracic aorta (TAA)
- Abdominal aorta (AAA)
True – wall of artery forms aneurysm
a. Fusiform
b. Saccular
False
a. Pseudoaneurysm
b. Disruption of all arterial wall layers with bleeding into surrounding anatomic structures
Thoracic aneurysm (TAA) Clinical Manifestations
chest pain (deep, diffuse extending into interscapular area
Ascending aorta and aortic arch Clinical manifestations
a. angina
b. transient ischemic attacks (TIAs)
c. coughing, shortness of breath
d. hoarseness and/or difficulty swallowing – from pressure on laryngeal nerve
e. if presses on superior vena cava, decreased venous return leading to JVD, edema of face and arms
Abdominal aortic aneurysm (AAA) clinical manifestations
a. palpable pulsatile mass
b. bruit over aneurysm
c. abd or back pain, epigastric discomfort
d. altered bowel elimination
e. intermittent claudication
f. “blue toe syndrome”
-patchy, mottling of feet and toes with pulses present
Complications- Aneurysm rupture
a. Diaphoresis
b. Pallor/ clammy skin
c. Weakness
d. Tachycardia
e. Hypotension
f. Abdominal, back, groin or periumbilical pain
g. Changes in LOC
h. Pulsating abdominal mass
f. decreased uop
Complications - Rupture into retroperitoneal space
severe back pain or flank ecchymosis (grey turners sign)
Complication- Rupture into thoracic or abdominal cavity
pt can die from Massive hemorrhage
Diagnostic studies
a. Chest x-ray – to reveal abnormal widening of the thoracic aorta.
b. Abdominal x-ray – shows calcification within aortic wall
c. 12-lead ECG – to rule out an MI
d. Echocardiography – assess the function of valve
e. Ultrasound – monitor aneurysm size
f. CT or MRI- diagnose and assess location and severity of aneurysm
g. Angiography- can map the entire aortic system
Medical management aneurysm < 5.4 cm
a. Early detection and prompt treatment
b. Monitor growth aneurysm over time
c. Risk factor modification
d. Manage hypertension
e. AAA – if < 5.4 cm and asymptomatic
f. Ultrasound or CT every 6-12 months if 4-5.4 cm (<4 cm -ultrasound every 3 years)
Surgical intervention
a. Utilized for AAA 5.5 cm or >, if symptomatic, high risk rupture
b. If aneurysm ruptures, requires emergency surgical intervention
c. Open aneurysm repair (OAR)
d. Endovascular graft (EVAR) minimally invasive repair
Endovascular graft (EVAR) minimally invasive repair
(1) post procedure angiography to check for leaks and confirm Patency
(3) Potential complications: endoleak, aneurysm growth, Aneurysm rupture, aortic dissection, bleeding, renal artery Occlusion
Potentially lethal complication in emergency repair
-Intraabdominal hypertension (IAH)
*Associated with abdominal compartment syndrome
Preop management
(a) mark peripheral pulse sites
(b) Medications – IV antibiotic, betablocker if h/o CVD
Postop management
(a) mark peripheral pulse sites
(b) Medications – IV antibiotic, betablocker if h/o CVD
(2) Postop management
(a) Airway management
(b) Arterial line, RAP, ECG monitoring, O2 sat
(c) May have chest tubes
(d) Pain control
(e) Maintain graft patency -normal BP, IV fluid and blood products, RAP or PAP monitoring, UOP hourly, avoid (hypertension) (meds)
(f) Manage cardiovascular status -ECG monitoring, electrolyte monitoring, ABGs, O2, Meds, pain control
(g) Prevent infection
(h) Manage GI status -monitor for paralytic ileus and assess for bowel ischemia (absent bowel sounds, fever, abd distention, diarrhea, bloody stools)
(i) Monitor neurologic status
(j) Monitor peripheral perfusion -Doppler as needed , Absence in lower extremity pulses (temp) -absent pulses + cool/pale/mottled or painful extremity means embolization or graft occlusion -> report immediately
(k) Monitor renal function-hourly UOP, I&O, daily weight, RAP, BUN & Creatinine
Teaching
(a) Gradually increase activities as prescribed to
moderate physical activity
(b) No heavy lifting for 6 weeks
(c) Teach signs symptoms of infection & neurovascular
Changes -Report redness, swelling, increased pain, drainage from incision, temperature > 100F
-Report changes color, warmth of extremities
(d) Teach to check peripheral pulses
(e) Sexual dysfunction common after aortic surgery
Aortic dissection
- Sudden tear in intimal layer of aorta that creates a false lumen
- May occlude major branches of aorta causing decreased blood supply to Brain, abdominal organs, kidneys, spinal cord, and/or extremities
- Hypertension most important risk factor
- Dissection at risk for rupture
Type A
ascending aorta and arch – requires emergency surgery
Type B
dissection begins descending aorta – may use conservative Management
Type A– ascending aorta and arch CM
abrupt onset of severe anterior chest pain or back pain
