ANEURISMS

BINAL JOSHI
M. SC. NURSING

ANEURYSM

DEFINITION
Aneurysm is a localized, blood-filled balloon-like bulge in the wall

of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain (the circle of Willis) and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart.
When the size of an aneurysm increases, there is a significant risk

of rupture, resulting in severe hemorrhage, other complications or death.

DEFINITION: AORTIC ANEURISM

Abnormal dilation of a blood vessel at a site of weakness

or a tear in the vessel wall.

Usually secondary to atherosclerosis.
Most commonly affect the aorta

CLASSIFICATION

TRUE ANEURISM

FALSE ANEURISM

TRUE ANEURYSM

A true aneurysm is one that involves all three layers

of the wall of an artery (intima, media and adventitia).

True aneurysms include atherosclerotic, syphilitic,

and congenital aneurysms, as well as ventricular aneurysms that follow transmural myocardial infarction

FALSE ANEURYSM :

A false aneurysm or pseudo-aneurysm does not primarily involve such distortion of the vessel.
out of an artery or vein, but confined next to the vessel by the surrounding tissue.

It is a collection of blood leaking completely

FALSE ANEURYSMS

May result from

Trauma Infection After peripheral artery bypass graft surgery at site of

anastomosis
Arterial leakage after cannulae removal

MACROSCOPIC SHAPE AND SIZE :

FUSIFORM ANEURISM

SACCULAR ANEURISM

FUSIFORM ANEURISM:

Fusiform Fusiform ("spindle-shaped") aneurysms

are variable in both their diameter and length; their diameters can extend up to 20 cm (8 in). They often involve large portions of the ascending and transverse aortic arch, the abdominal aorta, or less frequently the iliac arteries

Fusiform

Most AAA are fusiform and 98% are below the renal artery

SACCULAR ANEURYSM

Saccular aneurysms are spherical in shape and involve only a portion of the vessel wall; they vary in size from 5 to 20 cm (8 in) in diameter, and are often filled, either partially or fully, by thrombus.

ACCORDING TO LOCATION :

Aortic

Thoracic

Arterial and venous

Cerebral aneurysm

Peripheral Aneurysms

Brain Aneurism

CLINICAL MANIFESTATIONS
Frequently asymptomatic May have sub sternal, neck or back pain Coughing, due to pressure placed on the windpipe (trachea) Hoarseness Difficulty swallowing Swelling (edema) in the neck or arms Myocardial infarction, or stroke due to dissection or rupture involving the

branches of the aorta

DIAGNOSIS
X-rays- Most are diagnosed without

symptoms on routine X-ray

Chest - Demonstrate abnormal widening of

thoracic aorta
Abdomen -May show calcification within wall of

AAA

ECG -to rule out MI

DIAGNOSIS
Echocardiography
Assists in diagnosis of aortic valve insufficiency
Related to ascending aortic dilation

Ultrasonography
Useful in screening for aneurysms

Monitor aneurysm size

DIAGNOSIS
CT scan
Most accurate test to determine
Anterior to posterior length

Cross-sectional diameter
Presence of thrombus in aneurysm

MRI
Diagnose and assess the location and severity

DIAGNOSIS
Angiography
Anatomic mapping of aortic system using contrast

Not reliable method of determining diameter or length

Can provide accurate info about involvement of

intestinal, renal or distal vessels

AORTIC ANEURYSM CLINICAL MANIFESTATIONS

May mimic pain associated with abdominal or back disorders Pain correlates to the size- can be excruciating

May spontaneously embolize plaque

Causing blue toe syndrome patchy mottling of feet/toes with presence

of palpable pedal pulses

It can rupture, causing shock and death in 50% of rupture cases

COMPLICATION AORTIC DISSECTION

Blood invades or dissects the layers of the vessel wall- most often

thoracic Dissecting aneurysms are unique and life threatening. A break or tear in the tunica intima and media allows blood to invade or dissect the layers of the vessel wall. The blood is usually contained by the adventitia, forming a saccular or longitudinal aneurysm.

 Affects men more often than

women
Occurs most frequently between

fourth and seventh decades of life

Acute and life threatening

Mortality rate 90% if not

medically or surgically treated

Manifes ta tions of A ortic D is s ection A neurys m

A brupt, s evere, ripping or tea ring pa in in a rea of a neurys m Mild or ma rked hypertens ion ea rly Weak or a bs ent puls es a nd blood pres s ure in upper extremities S ync ope C omplica tions : hemorrha g e, is c hemic kidneys (rena l fa ilure), MI, hea rt fa ilure, c a rdiac ta mpona de, s eps is , wea knes s or pa ra lys is of lower ex tremities .

AORTIC DISSECTION COLLABORATIVE CARE

Initial goal
BP and myocardial contractility to diminish pulsatile forces within aorta

Drug therapy
IV -adrenergic blocker
Esmolol (Brevibloc)

Other hypertensive agents

Calcium channel blockers Sodium Nitroprusside

Angiotensin-converting enzyme

AORTIC DISSECTION
Surgical therapy
When drug therapy is ineffective

or
When complications of aortic dissection are present
Heart failure, leaking dissection, occlusion of an artery

Surgery may be delayed to allow edema to decrease

and permit clotting of blood.

Even with prompt surgical intervention
30-day mortality of acute aortic dissections remains high

(10%-28%)

Stent Graft Repair

NURSING MANAGEMENT: ASSESSMENT

Cardiovascular status
Continuous ECG monitoring Electrolyte monitoring Arterial blood gas monitoring Oxygen administration Antidysrhythmic/pain

Renal perfusion

status
Urinary output
Fluid intake Daily weight

CVP/PA pressure
Blood urea

medications

nitrogen/Creatinine

ASSESSMENT
Gastrointestinal status
Nasogastric tube Abdominal assessment
Infection
Antibiotic administration Assessment of body

Passing of flatus is key

temperature
Monitoring of WBC Adequate nutrition Observe surgical incision

sign of returning bowel function

Watch for manifestations

of bowel ischemia

for signs of infection

ASSESSMENT Neurologic status

Level of consciousness Pupil size and response to light

Peripheral perfusion status

Pulse assessment
Mark pulse locations with

felt-tip pen
Extremity assessment (5Ps) Temperature, color,

Facial symmetry
Speech Ability to move upper

extremities
Quality of hand grasps

capillary refill time, sensation and movement of extremities

NURSING DIAGNOSIS

Risk for Ineffective

Tissue Perfusion
Risk for Injury Anxiety Pain

Knowledge Deficit

NURSING MANAGEMENT

Ambulatory and Home Care

Encourage patient to express concerns Patient instructed to gradually increase activities

No heavy lifting
Educate on signs and symptoms of complications Infection Neurovascular changes

PREVENTION
1.Ultrasound is extremely effective at detecting AAAs.The U.S. Preventive Services Task Force (USPSTF) recommends that anyone aged 65 to 75 who has ever smoked undergo a one-time ultrasound screening for AAA 2.Prevent atherosclerosis 3.Treat and control hypertension 4.Diet- low cholesterol, low sodium and no stimulants

5.Careful follow-up if less than 5cm. It can grow .5cm /year

OTHER COMPLICATIONS

Rupture- signs of ecchymosis (triad) Back pain Hypotension Pulsating mass

Thrombi

Renal Failure

RUPTURE TRIAD

Back pain

Hypotension

Pulsating hematoma