Aortic Aneurysm Repair Flashcards
A bulge or ballooning (weakening) in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body.
Aortic Aneurysm
* Think of it like a weak spot in a tire that bulges out as pressure builds up.
Are aneurysms and dissection similar?
No.
Can happen together but they are different.
What is this?
Aortic Aneurysms
What is this?
Aortic Dissection
2 Types of Aortic Aneurysms
Abdominal Aneyrysm
Thoracic aneurysm
Which type of Aneurysm is the worst one?
Both are equally dangerous.
2 main surgical procedures used for Aortic Aneurysms
- AAA REpair (OAR)
- Endovascular Stent Graft (EVAR)
AAA Graft stands for
ABDOMINAL aortic Aneurysm Graft
- very invasive procedure where abdomen is cut opened.
Another term used for AAA Graft surgery
Open Aneurysm Repair (OAR)
What major organ implication can occur with AAA Graft/OAR procedure?
Implication for KIDNEY function due to calmping the renal artery during surgery.
Also, where is the aortic vessel in comparisson to your organs?
Aorta sits BEHIND all of your intestines.
What is a POST-OP complication with AAA Graft/OAR procedure in regards to pt’s intestines/organs?
Intestines and organs are manipulated to gain surgical access to aorta- bc of this ILEUS may occur.
Review:
What is ILEUS?
Stops peristalsis in the intestines, preventing food, liquids and gasses to pass through, leading to complete or partial intestinal obstruction
AAA Graft/ OAR MOST important POST-OP Assessment
Maintain adequate BP
Why is maintaining BP important for AAA Graft/ OAR procedure?
- HYPOtension can lead to thrombosis (blood clot) and loss of patency
- Potential for renal injury if kidneys aren’t adequately perfused (perfussion is important)
- Severe HYPERtension can cause leaks or rupture
What would we give to maintain a stable BP for these patients POST-OP AAA Graft/ OAR?
- maintained with fluids
OR - IV vasoactive drugs
2 Vasoactive drugs that INCREASE BP
- norepinephrine
- dopamine
2 Vasoactive drugs that DECREASE BP
- nicardipine-CCB drug
- NTG
Other Post-Op assesstments after OAR/AAA Repair
- Watch for infection- on site, systemic, check WBC
- Frequent abdominal assessment- abdominal girth/ bowel sounds
- STRICT NPO- no ice , nothing!
- Neurovascular checks (6 P’s)
- Renal perfusion- urine output, perfussion **
What body meassurement are we checking during abdominal assessment?
Specific to AAA/OAR
measurement of abdominal girth
If abdominal girth has increased, what may be occuring internally?
internal bleeding or Ileus (ileus is common after this procedure)
* think of it as abdominal tamponade
Another type of Aortic aneurysm procedure but LESS invasive
Endovascular Stent Graft (EVAR)
- minimally invasive procedure where a stent graft is inserted through small incisions in the groin using a catheter.
Benefits of EVAR surgery
- LESS invasive
- shorter recovery time
- Can eat & drink after
- Pts are able to move around more frequently
- No risk of Ileus
POST-OP Care for EVAR repair
- Monitor groin punctures
- Monitor femoral and pedal pulses (6P’s) - same as cardiac cath (PCI)
- Routine follow up scans (CT or MRI)- monitor future implications
Open Repair for Thoracic Aortic aneurysms are similar to
Open heart surgery and require a STERNOTOMY
Thoracic Endovascular Repair is similar to an EVAR except it is called
TEVAR
What may be different in an TEVAR?
sites used for the repair may be different than EVAR.
- May be multiple (ie: upper arm and groin)
- Assess these sites **
Can a TEVAR patient suffer from Ileus?
No! Ileus occurs in the abdomen where the stomach organs are.
- think of this stuff on the test!! **
