Aneurysm Visual Aid

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ANEURYSM



Layers of the aorta tunica intima: innermost layer of an

artery - direct contact with the flowing

blood

tunica media: adjacent to intima:

composed of smooth muscle cells and

elastic tissue

tunica adventitia or tunica externa:

outermost layer

layer is composed of tougher connective

tissue



saccular aneurysm resembles a small

bubble that appears off

the side of a blood

vessel

saccular aneurysm

develops when fibers in

the outer layer separate

allowing the pressureof the blood to force the

two inner layers to

balloon through



fusiform aneurysm is a bulging around

the entire

circumference of the vessel without

protrusion of the

inner layers. It is

shaped like afootball or spindle.



pseudoaneurysm does not primarily involve such

distortion of the vessel

a collection of blood leaking

completely out of an artery or

vein, but confined next to the vessel by the surrounding tissue

blood-filled cavity will eventually

either thrombose (clot) enough

to seal the leak or it will ruptureout of the tougher tissue

enclosing it and flow freely

between layers of other tissues

or into looser tissues



Risk factors Smoking. High blood pressure

Atherosclerosis

Sex Race

Family history

Infection or inflammation (vasculitis) Marfan syndrome



Symp toms A pulsating sensation near the navel

Tenderness or pain in the abdomen or

chest Back pain



Symp toms A small, unchanging aneurysm will

produce no symptoms

Before a larger aneurysm ruptures : ² a sudden and unusually severe headache,

² nausea,

² vision impairment,

² vomiting,

² loss of consciousness



Classification of rup turedaneurysm severity



Hunt and Hess scale of

subarachnoid hemorrhage severity Grade 1: Asymptomatic; or minimal

headache and slight nuchal rigidity.

Approximate survival rate 70%. Grade 2: Moderate to severe

headache; nuchal rigidity; no

neurologic deficit except cranialnerve palsy. 60%.

Grade 3: Drowsy; minimal neurologic

deficit. 50%.



Grade 4: Stuporous; moderate to

severe hemiparesis; possibly early

decerebrate rigidity and vegetativedisturbances. 20%.

Grade 5: Deep coma; decerebrate

rigidity; moribund. 10%. Grade 6: Instant Death

Hunt and Hess scale of subarachnoidhemorrhage severity



T horacic aortic

aneurysm 85 % is caused

by

atherosclerosis Between ages 40

to 70 years old

Most commonsite of aneurysm

1/3 dies due to

rupture



Clinical Manifestation

Constant boring painduring supine

position

Dyspnea (pressureagainst the trachea)

Cough

Hoarsheness Stidor

Aphonia

Dysphagia



Assessment Superfacial veins of the

chest and neck or arms

are dilated (pressure of

aneurysm) Edematous areas on the

chest wall

C

yanosis Unequal pupil (pressure

in the cervial

sympathetic chain)

Descending

Thoracic

Aneurysm



diagnostics Chest-X ray

Transesophageal

echocardiography(TEE)

CT



MEDIC ALMANAGEMEN

T Surgical repair

Control blood

pressure Correct risk factors



Figure 5 Surgical options for aneurysms of the ascending aorta include:

(A) graft replacement of the ascending aorta beginning above thesinotubular junction, here shown with hemiarch replacement distally;

(B) separate valve and graft replacement; (C) composite root

replacement with a mechanical prosthesis, although a biological root

prosthesis can be substituted; and (D) a valve-sparing David

reimplantation procedure



Abdominal

aneurysm Common caused

by atherosclerosis

Affects men 4times more that

women

Caucasians

Most prevalent in

elderly

Below renal artery



Clinical manifestations

40 % have symptoms Heart beating in the

abdomen

Abdominal mass orthrobbing

Cyanosis and mottling

of the toes (cholesterol,platelet or fibrin lodge

in the interosseos or

digital arteries)



Assessment &

diagnostic findings Pulsatile mass in the

middle and upper

abdomen

Can be palpated

Systolic bruit heard

over mass

Duplex

ultrasonography or

CT



MedicaManagement

Pharmacologic therapy

² Antihypertensive

medications (to maintain

blood pressure)

Surgical management

² Endovascular grafting

Involves the transluminalplacement and attachment

of a sutureless aortic graft

prosthesis across the

aneurysm Endovascular

grafting



N

ursingManagement



Goal: provide emergency care beforesurgery for dissection or rup ture

Vital signs: frequent depending on

severity

I V monitoring

Urine output monitoring 15-30 mins

O2 inhalation

Administer antihypertensive asordered

Transport to OR quickly

Observe the general pre-operative care



Goal: prevent complications post-op

² Vital signsCVP

Peripheral pulses hourly

² Position : initially flat Turn to sides

Note erythema on back from pooled

blood Turn to sides

Note erythema on back from pooled

blood



Goal: promote comfort Position : alignment, comfort,

prevent ulcers

Administer medication: narcotic



Goal: health teaching Minimize recurrence

² avoid trauma,

² infection, ² smoking,

² high cholesterol diet,

² obesity

Regular medical supervision

Aneurysm Visual Aid

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