1 / 19/ 2017

Atherosclerosis
Hypertension
Smoking
Men
Genetic
Predisposition

Bulging and stretching of aorta

Damages media / intima layers

Thoracic aorta Ascending, arch,

descending
Abdominal aorta
Peripheral Popliteal or femoral
artery

 Most common in :
Thoracic aorta
Aortic arch
Predisposing factors:
Chronic hypertension
Marfan syndrome

 May be asymptomatic
Back, neck, or chest pain
Facial / neck edema
Ascending or aortic arch
Dyspnea, stridor, or brassy
cough
Hoarseness and dysphagia

Pulsating abdominal mass

Lower back, midabdominal,

or flank pain

Systolic bruit

Cold, cyanotic
extremities

TAA

AAA

Rupture

Emboli to lower
extremities

Hemorrhage

Rupture

Hemorrhage

Sudden severe abdominal pain

Abdominal rigidity

Palpable abd. mass

Posterior rupture Grey Turners
sign
Complication: Shock

Grey Turners sign

Sudden, severe, tearing or

ripping pain in area of
aneurysm

Dizziness, altered LOC

Hypertension

Unequal BP between arms

 High mortality w/ aortic arch

dissection
Hemorrhage
Cardiac tamponade
MI, HF, ARF

 Chest X-ray
CT scan and MRI
Abdominal ultrasound
Transesophageal
echocardiogram
Angiography

 Monitor size w/ ultrasonography

OR for > 5 cm
Or
Impending rupture

Control BP / Risk factors

 Emboli to distal extremities

Ischemia due to cross clamping aorta
Significant blood loss
Use autotransfusion
(Cell Saver)

1. Monitor:
a. Neuro status - Emboli
b. Cardiac rhythm - Dysrhythmias, MI
c. Hemodynamics - Hypovolemic shock
d. Respiratory - Atelectasis, pneumonia
e. Acid-base, lytes - Dysrhythmias

2. Crystalloids and colloids

Promote graft patency
3. IV antihypertensives
esmolol (Brevibloc), labetalol,
nitroprusside
Prevent pressure on graft
site(s)
***Keep SBP < 120***

 Ecchymosis of scrotum, perineum, or

penis;
new or expanding hematoma
abdominal girth; H & H
Weak / absent PP; P, BP, PAWP, UOP
CMS in extremities
abdominal, pelvic, back, or groin
pain

Pain / numbness in lower

extremities

Decreasing pulses

Pale, cool, or cyanotic skin

Mark pulse location with felt

pen

Mesenteric / Bowel Ischemia

Abdominal pain / distention
to absent BTs
Occult or fresh blood in stool
Impaired

- UOP < 0.5 ml/kg/hour

Spinal cord ischemia - Lower extremity

weakness

5. Control pain - PCA or epidural

6. Prevent infection
** Broad-spectrum ATBs
**Infected grafts require
surgery
7. Address anxiety of patient and
family

Emergent Surgery

High mortality!

Multiple potential complications

Usually hypovolemic shock

Support family/patient

Limit progression of dissection!

1.

Beta-blockers IV

esmolol (Brevibloc)
or

labetalol (Transdate)

2.

nitroprusside (Nitropress) infusion

3. Monitor:

Keep O2 saturation > 94%

Cardiac rhythm
Hemodynamic status

4. Morphine / tranquilizers pain /

anxiety
5. When stable, expect open repair
surgery

 Prescribed antihypertensives

Wound care ; S/Sx infection

Activity / lifting limitations (4-6 weeks)

Prevent constipation / straining

S/Sx complications; when to call HCP

No driving for 1 to 2 weeks

Only ingest a diet low in sodium and cholesterol
The importance of maintaining a healthy weight
Get emergency help if you are experiencing
chest pain or other S/Sx of dissection

Only lift things under 5 lbs for 4 to 6 weeks

Incision must be kept clean and dry
Need for repeat CT scan at 1, 6, and 12 months
Go to your HCP for scheduled appointments

The importance of aneurysm screening for

at-risk family members (particularly those
who have HTN, smoke, or are older)

Observe for any S/Sx of dissection

Dont smoke
Include daily exercise when cleared by HCP
Emphasize the importance of taking
medications as prescribed