THE SITUATION

Over 15,000 people in the U.S. died last year from ruptured

abdominal aortic aneurysms (AAA). AAAs are the tenth leading cause of death in men over 50. An estimated 1 million men and women worldwide are living with undiagnosed AAAs. Could your patient have an undiagnosed AAA?

Aneurysms of Central Arteries

Aneurysma permanent localized dilation of an artery, enlarging the artery to twice its normal diameter

Aneurysms
Thoracic aortic aneurysm Abdominal aortic aneurysm

Aortic dissection

Characteristics of Arterial Aneurysms

Assessment of Abdominal Aortic Aneurysm (AAA)

Pain

related to AAA is usually steady with a gnawing quality, is unaffected by movement, and may last for hours or days. is in the abdomen, flank, or back. mass is pulsatile.

Pain

Abdominal Rupture

is the most frequent complication and is life threatening.

Assessment of Thoracic Aortic Aneurysm

Assess

for back pain and manifestation of compression of the aneurysm on adjacent structures. for shortness of breath, hoarseness, and difficulty swallowing. a mass may be visible above the suprasternal notch. excruciating back or chest pain is symptomatic of thoracic rupture.

Assess

Occasionally

Sudden

Diagnostic Assessment
X-ray CT Aortic

eggshell appearance

arteriography Ultrasonography

 Monitor

Nonsurgical Management

the growth of the aneurysm.

Maintain

BP at a normal level to decrease the risk of rupture.

 Preoperative Operative

Abdominal Aortic Aneurysm Resection

care procedure care:

Postoperative

Monitor vital signs Assess for complications Assess for signs of graft occlusion or rupture

 Preoperative Operative

Thoracic Aortic Aneurysm Repair

care procedure care assessments:

Postoperative

Vital signs Complications Sensation and motion in extremities Respiratory distress Cardiac dysrhythmias

Aortic Dissection

May be caused by a sudden tear in the aortic intima, opening the way for blood to enter the aortic wall Pain described as tearing, ripping, and stabbing

Aortic Dissection (Contd)

Emergency

care goals include:

Elimination of pain Reduction of blood pressure Decrease in the velocity of left ventricular ejection

Nonsurgical Surgical

treatment

treatment

AAA ESSENTIALS
Definition
Diameter of the aorta 1.5 times

greater than normal. Most are infrarenal, and a significant number extend down into one or both iliac arteries.

AAA ESSENTIALS
Scope of the Challenge

Approximately 200,000 are diagnosed in the U.S. each year.

15,000 Americans died of this condition in 2007. 75% produce no symptoms. 75% are detected incidentally usually during imaging scans.

Mortality rate: When AAAs rupture, only 18% of patients survive.

WHO IS MOST AT RISK?

Primary Risk Factors

Men over 60

Men are four times more likely to develop AAAs, but 20% do occur in women.

Smokers

Current smokers are seven times more likely to develop AAA than non-smokers. Former smokers are three times more likely.

Family History

20% of AAA patients have a relative with the condition.

WHO IS MOST AT RISK?

Secondary risk factors:

Obesity High blood pressure High cholesterol Atherosclerosis Cardiovascular disease

SYMPTOMS
Although there are frequently no symptoms, AAA symptoms may include:

Pain or tenderness in the lower back, abdomen or side Throbbing in the abdomen Indications of rupture may include:

Lightheadedness Sweating Clammy skin Nausea

DIAGNOSIS

Physical examination of abdomen

Abdominal tenderness may indicate an AAA

Bruit over the aorta Palpable mass

Not effective in obese patients and/or those with an AAA under 2 cm in diameter

Usual: abdominal ultrasound >80% accurate As required: MRI, CT or other imaging systems Angiography rarely indicates

TREATMENT OPTIONS

AAAs under 5 cm in diameter: usually monitored with serial ultrasound examinations AAAs 5 cm and larger: usually repaired with open surgery or endovascular repair

No proven lifestyle changes can decrease the size of AAAs.

REPAIR OPTIONS

Both endovascular and open surgeries are used to repair AAAs. Approximately 40,000 repairs are performed each year in the U.S.

REPAIR OPTIONS
Endovascular Surgery

Requires two small incisions in the groin area. An endovascular graft is inserted through the femoral artery via a catheter and deployed inside the lumen, relining the aorta.

Average hospital stay: 2-3 days Average recovery time: 1-2 weeks

REPAIR OPTIONS
Open Surgery

Requires large abdominal or flank incision Retroperitoneal dissection and exclusion of the aneurysm by clamping the aorta Removal of the affected aorta and replacement with surgical graft

Average hospital stay: 1 week Average recovery time: 1-3 months

WHAT YOU CAN DO

Be aware AAAs are most often silent killers and are increasing in number.

Remember those most at risk:

Men over 60 Smokers Those with a family history of AAA

Screen as early as possible and refer to a specialist, as appropriate.