Aortic Aneurysms:
- Permanent, localized outpouching or dilation of the vessel wall
- Aortic ache and thoracic &/or abdominal aorta
- Asymptomatic
- AAA – ABDOMINAL AORTIC ANEURYSMS most common
- True fusiform abdominal aortic aneurysm
- True saccular aortic aneurysm
- False aneurysm, or pseudoaneurysm
- Aortic dissection
Aorta aneurysm above the kidney will be fear of filtration and flow to the kidney
< 4cm aneurism – watch CT scan and ultrasound Q2-3 years
4 – 5.4 cm – conservative medical therapy of small, asymptomative AAA
> 5.5 cm surgery
If the aneurysms have ruptured, emergent surgical intervention is required.
Risk factors:
- Tobacco use
- MALE
- African American
- Age
- HTN
- CAD
- Family history
- High cholesterol
- Lower extremity PAD
- Carotid artery disease: CAD
- Previous stroke
- Overweight or obesity
Manifestations:
- Chest pain
- Transient ischemia attacks from decreased blood flow to the carotid arteries
- Cough
- Shortness of breath, hoarseness,
- Dysphagia: difficulty swallowing from pressure on the laryngeal nerves
- Edema of the face and arm: aneurysm presses on the Superior Vena Cava, decreased
venous return in jugular venous distention
- Pulsatile mass in the periumblical area
- Back disorder
- Epigastric discomfort, altered bowel elimination and intermittent claudication
- Blue toe syndrome (patchy mottling of the feet and toes in the presence of palpable
- pedal pulses
Diagnostic: MRI
, - Xray: chest and abdominal
- ECG to rule out MI
- Echocardiography assess the f(x) of the aortic valve
- Ultrasound for aneurysm screening and its size
- CT scan: MOST ACCURATE to determine the length and cross-sectional diameter and the
presence of thrombus in the aneurysm
- Angiography
Management:
- H&P assessment
- Signs of coesxisting cardiac, pulmonary, cerebral, and lower extremity vascular problems
- Monitor for signs of rupture: diaphoresis, pallor, tachycardia, level of consciousness,
hypotension, weakness, or a pulsating abdominal mass
- Establish baseline data
- Pay attention to the character & quality of the pt’s peripheral pulses, renal, and neuro
status
- Medications
o Beta blockers
o ACE Inhibitors
o Angiotension II receptor blockers
o Statins
o Antibiotics
- Educations:
o Smoking cessation
o Bleeding
o Death from massive hemorrhage (hypovolemic shock, tachycardia, hypotension,
pale clammy skin, decreased urine output, altered level of consciousness, and
abdominal tenderness)
Acute Care Preop:
- Emotional support and teaching
- A brief explanation of the disease process, the planned surgical procedures, routines,
what to expect immediately after surgery, and postop timelines
- Bowel preparation: laxatives, enemas
- Skin cleansing
- NPO after midnight
- Receive IV antibiotics before incisionis made
- Pt with history of CVD: receive B blockers (metoprolol)
Acute Care Post-op:
- ICU for 24-48 hrs for close monitoring
- Endotracheal tube for mechanical ventilation
- Arterial line/Central venous pressure
- Pulmonary artery catheter
- Peripheral IV lines
- Permanent, localized outpouching or dilation of the vessel wall
- Aortic ache and thoracic &/or abdominal aorta
- Asymptomatic
- AAA – ABDOMINAL AORTIC ANEURYSMS most common
- True fusiform abdominal aortic aneurysm
- True saccular aortic aneurysm
- False aneurysm, or pseudoaneurysm
- Aortic dissection
Aorta aneurysm above the kidney will be fear of filtration and flow to the kidney
< 4cm aneurism – watch CT scan and ultrasound Q2-3 years
4 – 5.4 cm – conservative medical therapy of small, asymptomative AAA
> 5.5 cm surgery
If the aneurysms have ruptured, emergent surgical intervention is required.
Risk factors:
- Tobacco use
- MALE
- African American
- Age
- HTN
- CAD
- Family history
- High cholesterol
- Lower extremity PAD
- Carotid artery disease: CAD
- Previous stroke
- Overweight or obesity
Manifestations:
- Chest pain
- Transient ischemia attacks from decreased blood flow to the carotid arteries
- Cough
- Shortness of breath, hoarseness,
- Dysphagia: difficulty swallowing from pressure on the laryngeal nerves
- Edema of the face and arm: aneurysm presses on the Superior Vena Cava, decreased
venous return in jugular venous distention
- Pulsatile mass in the periumblical area
- Back disorder
- Epigastric discomfort, altered bowel elimination and intermittent claudication
- Blue toe syndrome (patchy mottling of the feet and toes in the presence of palpable
- pedal pulses
Diagnostic: MRI
, - Xray: chest and abdominal
- ECG to rule out MI
- Echocardiography assess the f(x) of the aortic valve
- Ultrasound for aneurysm screening and its size
- CT scan: MOST ACCURATE to determine the length and cross-sectional diameter and the
presence of thrombus in the aneurysm
- Angiography
Management:
- H&P assessment
- Signs of coesxisting cardiac, pulmonary, cerebral, and lower extremity vascular problems
- Monitor for signs of rupture: diaphoresis, pallor, tachycardia, level of consciousness,
hypotension, weakness, or a pulsating abdominal mass
- Establish baseline data
- Pay attention to the character & quality of the pt’s peripheral pulses, renal, and neuro
status
- Medications
o Beta blockers
o ACE Inhibitors
o Angiotension II receptor blockers
o Statins
o Antibiotics
- Educations:
o Smoking cessation
o Bleeding
o Death from massive hemorrhage (hypovolemic shock, tachycardia, hypotension,
pale clammy skin, decreased urine output, altered level of consciousness, and
abdominal tenderness)
Acute Care Preop:
- Emotional support and teaching
- A brief explanation of the disease process, the planned surgical procedures, routines,
what to expect immediately after surgery, and postop timelines
- Bowel preparation: laxatives, enemas
- Skin cleansing
- NPO after midnight
- Receive IV antibiotics before incisionis made
- Pt with history of CVD: receive B blockers (metoprolol)
Acute Care Post-op:
- ICU for 24-48 hrs for close monitoring
- Endotracheal tube for mechanical ventilation
- Arterial line/Central venous pressure
- Pulmonary artery catheter
- Peripheral IV lines
