INDEX

TOPIC : AORTIC ANEURYSM

SR.NO. CONTENT REMARKS

1 Introduction
2 Definition
3 Incidence
4 Classification
a) True aneurysm
b) False aneurysm
5 Types
a) Thoracic aortic aneurysm
b) Abdominal aortic aneurysm
6 Causes & risk factors
7 Pathophysiology
8 Signs & symptoms
9 Diagnostic Evaluation
10 Management
i) Medical management
ii) Surgical management
iii) Nursing management
11 Complications
12 Bibliography

SUBMITTED BY : Priyanka Thakur

ROLL NO. : 11
 AORTIC ANEURYSM

INTRODUCTION:- Aneurysm are outpouching or dilations of the arterial wall & are common
problems involving the aorta. Aneurysm of peripheral arteries also can occur but are far less
common.

DEFINITION:-

 Aneurysm is a localized sac or dilation formed at a weak point in the wall of the aorta.
 An aneurysm is an abnormal bulge in the wall of a blood vessel. A larger bulge, more
than 1.5 times the size of normal aorta, is called an aneurysm.

INCIDENCE:-

 30-60/1000
 Increasing incidence over past 3 decades
 Carotid Artery Stenosis - 10%
 Smoker: Nonsmoker - 8:1
 Male: Female - 4:1
 HTN - 40% of pts
 Most aneurysm are found in the abdominal aorta below the level of the renal arteries.
 3/4th of true aortic aneurysms occurs in the abdominal aorta & 1/4th in the thoracic aorta.
 Popliteal artery aneurysm rank third in frequency.

CLASSIFICATION :- Aneurysm may be classified by its shape and form:-

A. True aneurysms:- One, two and all three layers of artery may be involved. It is
classified into different types:-

 Fusiform aneurysms:- Symmetric, spindle- shaped expansion of entire circumference of

involved vessel. It appears as symmetrical bulges around the circumference of the aorta.
They are the most common shape of aneurysm.
 Saccular aneurysms:- A bulbous protrusion, asymmetrical and appear on one side of
the aorta. They are usually caused by trauma or a severe aortic ulcer.
 Dissecting aneurysms:- A bilateral out pouching in which layers of the vessels wall
separate ,creating a cavity. This is usually is a haematoma that split the layer of arterial
wall.

B. False aneurysms (Pseudoaneurysm ) :-The wall rupture and a blood clot is retained in
an out pouching of tissue or there connection between and artery that does not close.
TYPES:-The two types of aortic aneurysm are:

 Thoracic Aortic Aneurysms :- develop in the part of the aorta that runs through the chest.
This includes the ascending aorta (the short stem of the cane); the aortic arch (the cane
handle); and the descending thoracic aorta (the longer stem of the cane).
 Abdominal Aortic Aneurysms:- develop in the part of the aorta that runs through the
abdomen. Most abdominal aortic aneurysms develop below the renal arteries (the area where
the aorta branches out to the kidneys). Sometimes aortic aneurysms extend beyond the aorta
into the iliac arteries (the blood vessels that go to the pelvis and legs).
CAUSES:-The exact cause is unknown. But recent evidence includes:-

 Atherosclerosis (most common)

 Hypertension

Congenital:-

 Primary connective tissue disorder Inflammatory (Noninfectious):-

(Marfan’s syndrome)
 Turner disorder  Takayasu’s disease
 Gaint cell arteries
Mechanical disorder:-  Lupus erthmatous disease

 Post stenotic and arteriovenous Infectious:-

fistula
 Amputation related  Bacterial
 Fungal
Turmatic (Pseudoaneurysm):-
Pregnancy related degenerative:-
 Penetrating arterial injuries
 Blunt arterial aneurysm  Non-specific
 Pseudoaneurysm  inflammatory disease

RISK FACTORS:-

 CAD  Tobacco use

 Hypertension  Peripheral vascular disease
 Hypercholesterolemia  Marfansyndrome
 Elevated C-reactive protein

PATHOPHYSIOLOGY:-

Due to etiological causes ( Environment, atherosclerosis, smoking, inflammation, Genetic

Factors)

Elastase activity increases versus inhibition decreases

Elastin destruction

Collagen remodelling Failure of elastin Hypertention

Increase load on collagen Ageing

Failure of collagen

Alteration in vessel geometry Aneurysm dilation

Rupture
CLINICAL MANIFESTATIONS:-

 Asymptomatic - 70-75%
 Symptoms:
 Deep, diffuse chest pain extend to the inter-scapular area
 Abdominal, Flank, or Back pain (due to pressure of aneurysm on the lumbar
nerves).
 1/3 of pts experience abdominal And flank pain
 Abrupt onset of pain -->Rupture or expansion of aneurysm

DIAGNOSTIC EVALUATION:-

Physical Exam: If <5cm in diameter, then cannot be detected by routine physical exam

Abdominal & chest X-Ray: May show calcification that outline aneurysm.

Ultrasound& echocardiography: These test can show the size of an aortic aneurysm.

CT-Scan: Shows the size & shape of an aneurysm.

MRI: Detect aneurysm & pinpointing their size & exact location.

Angiography: This test shows the amount of damage & blockage in blood vessels.

Complications:

 Thrombosis
 Distal embolization
 Rupture

THORACIC AORTIC ANEURYSM:-

INTRODUCTION:-

Approximately 85% of all cases of thoracic aortic aneurysm are caused by arthrosclerosis. They
occur most frequently in men between ages 40 and 70 years. The thoracic area is the most
common site for a dissecting aneurysm. About one third of patient with thoracic aortic aneurysm
die of rupture of aneurysm.

CLINICAL MANIFESTATIONS:-

Symptoms are variable and depend on how rapidly the aneurysm dilates and how the pulsating
mass affects surrounding intra thoracic structures. Some of the patients are asymptomatic. But
some are having:-

 Pain occur in supine position

 Dyspnoea
 Hoarseness
  Stridor
 Weakness
 Aphonia
 Dysphasia

ASSESSMENT AND DIAGNOSTIC TESTS:-

 Physical Examination:- superficial veins of neck, chest or arm dilated

 Chest X ray
 Echocardiography
 CT scan

TREATMENT:-

Goal:

 To prevent the aneurysm from rupturing.

 Treatment is based on the exact size & location of aneurysm.

MEDICAL MANAGEMENT:-

 Antihypertensive: - Hydralazine hydrochloride

 Beta blocker:- Atenolol, Timolol maleate
 Sodium nitroprusside used in emergency condition.

SURGICAL MANAGEMENT:-

Goal:

 To repair aneurysm.
 Restore vascular contuinity.

Endovascular graft placed percutaneously: With the use of special endovascular instruments,
along with X-ray images for guidance, a stent- graft will be inserted through the femoral artery &
advanced up into the aorta to the site of the aneurysm.
ABDOMINAL AORTIC ANEURYSM:-

INTRODUCTION:-
The most common cause of abdominal aortic aneurysm is arteriosclerosis. Affects men 4 times
more often than women and it is most prevalent in elderly patients. Most of this aneurysm occurs
below renal arteries. Untreated, the eventual outcome may be rupture and death.

CAUSES:-
 Congenital weakness
 Trauma or disease

RSK FACTORS:-
 Genetic predisposition
 Smoking
 Hypertension (50% cases)

CLINICAL MANIFESTATIONS:-
 Only 40% of patients with AAA have symptoms.
 Patient feel their heart beating in abdomen when lying down.
 Abdominal mass
 Abdominal throbbing
 Cyanosis & mottling of the toes.
If ruptured:
 Severe back or abdominal pain
 Falling B.P
  Retroperitoneal rupture of an aneurysm may result in hematoma in scrotum, perineum,
flank &penis.

ASSESSMENT AND DIAGNOSTIC TESTS:-

 Physical Examination:- superficial veins of neck, chest or arm dilated, pulsatile mass in
the middle & upper abdomen.
 Abdominal girth checked.
 Duplex ultrasonography or CTA for size, length & location of aneurysm.
 CT scan:- determine size, length and location of aneurysm

TREATMENT:- For individual with small aneurysm(<4cm) conservative therapy is iniated

with:
 Modification of risk factors.
 Decreasing blood pressure.
 Monitoring aneurysm size every 6 months using USG, CT or MRI.

MEDICAL MANAGEMENT:-

Medical therapy of aortic aneurysms involves strict blood pressure control. This does not treat
the aortic aneurysm, but control of hypertension within tight blood pressure parameters may
decrease the rate of expansion of the aneurysm.
The tetracycline antibiotic Doxycycline is currently being investigated for use as a potential drug
in the prevention of aortic aneurysm due to its metalloproteinase inhibitor and collagen
stabilising properties.
PREVENTION

Attention to patient's general blood pressure, smoking and cholesterol risks helps reduce the risk
on an individual basis. There have been proposals to introduce ultrasound scans as a screening
tool for those most at risk: men over the age of 65.

SURGICL MANAGEMENT:-

For abdominal aortic aneurysms suggest elective surgical repair when the diameter of the
aneurysm is greater than 5 cm (2 in).

OPEN SURGERY:-

Open surgery typically involves dissection of the dilated portion of the aorta and insertion of a
synthetic (Dacron or Gore-Tex) patch tube. Once the tube is sewn into the proximal and distal
portions of the aorta, the aneurysmal sac is closed around the artificial tube. Instead of sewing,
the tube ends, made rigid and expandable by nitinol wireframe, can be much more simply,
quickly and effectively inserted into the vascular stumps and there permanently fixed by external
ligature.
ENDOVASCULAR SURGERY:-

The endovascular treatment of aortic aneurysms involves the placement of an endo-vascular stent
via a percutaneous technique (usually through the femoral arteries) into the diseased portion of
the aorta. This technique has been reported to have a lower mortality rate compared to open
surgical repair, and is now being widely used in individuals with co-morbid conditions that make
them high risk patients for open surgery.

NURSING MANAGEMENT:
 The patient who have endovascular surgery must lie supine for 6 hours. The head of bed
may be elevated upto 45 degree after that.
 Monitor vital signs & Doppler assessment of peripheral pulses every 15 minutes initially.
 Usually femoral artery is assessed when vital signs & pulses are monitored.
 Assess for bleeding, pulsation, swelling, pain, & hematoma formation.
 Skin changes of lower extremity ,lumbar area or buttocks that might indicate signs of
embolization.
 The patient temperature should be monitored every 4 hours, & any sign of
postimplantation syndrome should be reported.

BIBLIOGRAPHY

 Suddarth’s & Brunner, “A Textbook of Medical Surgical Nursing” Wolters Kluwer,3rd

Edition 2019.Pp 656-658.
 Chintaman, “Medical Surgical Nursing”Elsevier Publishers, Edition 1st 2011 Page
No.896-899.