Miss.

Shalini
 DEFINITION

An aneurysm is an excessive localized

enlargement of an artery caused by
weakness in the arterial wall.
Aneurysms may remain silent or
Introducing
rupture, causing serious problems and
even death.
 TYPES OF
ANEURYSM

Type Morphological Location

1
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.

False aneurysm,pseudoaneurysm,
-is a collection of blood leaking
completely out of an artery or vein, but
confined next to the vessel by the
surrounding tissue. This blood-filled
cavity will eventually form either
thrombose (clot) enough to seal the leak,
or rupture out of the surrounding
tissue.[3]:357
Pseudoaneurysms can be caused by
trauma that punctures the artery, such
as knife and bullet wounds.
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 a thrombus.

Fusiform aneurysms ("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
1. Thoracic Aortic Aneurysm

Aneurysms that involve the aorta as it flows through chest are

called thoracic aortic aneurysms.

2. Abdominal Aortic Aneurysm

Aneurysm that involve the aorta as it flows through abdomen

are called abdominal Aortic Aneurysm
 INCIDENCE

§ - Approximately 85% of all cases of

thoracic aortic aneurysm are caused by
atherosclerosis.

§ This is occur most frequently in

men then women between 40 to 70 years.
(Thoracic aneurysm)

In abdominal aneurysm it affect mostly old age

People.
§ Most of these aneurysm occurs below the renal
arteries. Untreated disease leads to
death.(Abdominal aneurysm)

§ About one third of patient with thoracic

abdominal aneurysm die because of rupture of
thoracic aneurysm.
• Hardening of the arteries (atherosclerosis). As plaque
builds up on artery walls, they become less flexible, and the
additional pressure can cause them to weaken and bulge. High
blood pressure and high cholesterol are risk factors for
hardening of the arteries. This is more common in older
people.

• Genetic conditions. Younger people with an ascending

aortic aneurysm often have a genetic cause. People who are
born with the Marfan syndrome, a genetic condition that
affects the connective tissue in the body, are particularly at risk
of a thoracic aortic aneurysm

• Other medical conditions. Inflammatory conditions, such

as giant cell arteritis , may cause thoracic aortic aneurysms
• .Problems with your heart's aortic valve. Sometimes
people who have problems with the valve that blood flows
through as it leaves your heart (aortic valve) have an increased
risk of thoracic aortic aneurysm. This is mainly true for people
who were born with a bicuspid aortic valve, meaning the aortic
valve has only two cusps instead of three.

• Untreated infection. Though it is a rare cause of thoracic

aortic aneurysm, it's possible to develop this condition if
you've had an untreated infection, such as syphilis or
salmonella

• Traumatic injury. Rarely, some people who are injured in

falls or motor vehicle crashes develop thoracic aortic
aneurysms
 SIGN AND SYMPTOMS
Ø Thoracic aneurysm
o Pain-Constant and boring occur only when
the patient is in supine position.

o Dyspnea- It occurs when the pressure of the

aneurysm sac against the trachea, a main
bronchus, or the lung itself.

o Cough, stridor, hoarseness of voice

o Aphonia- Due to weakness or complete loss

of the voice resulting from pressure against
the laryngeal nerve.

Dysphagia- Can occur due to impingement on

the esophagus by the aneurysm
Ø Abdominal aneurysm

Only about 40% of patients with abdominal aortic aneurysm have symptoms

o Some patient complaint that they feel heart

beating their abdominal throbbing.

o Cyanosis and mottling of toes- It occurs

when small cholesterol ,platelet, fibrin
emboli may lodges in the interosseous or
digital arteries.
DIAGNOSTIC EVALUATION

Inspection- Cyanosis and mottling of toes, dilated veins of neck, chest or arms becomes
dilated.
Palpation- On palpation a pulsatile mass can be palpated at middle and upper abdomen.

Used to determine the size , length and

location of aneurysm.

- When the ultrasound is small then USG is

conducted at every 6 month of intervals until to
prevent any complication
 This
test helps in evaluating the atherosclerosis.

-Angiography test that uses dye

and special x rays to show the insides of your
arteries. This test shows the amount of damage
and blockage in blood vessels. Aortic
angiography shows the inside of your aorta. The
test may show the location and size of an aortic
aneurysm.
1. Medical Treatment

Ø Thoracic aneurysm

§ Antihypertensive drugs - Such as

hydralazine.
§ Beta –Blocker- Such as esmolol or
metoprolol.
§ Sodium nitroprusside- Nipride may be used
by continuous nitroprusside.
 § Antihypertensive Agent
§ Beta-Blocker
§ ACE inhibitor
§ Angiotensin11 receptor antagonist
§ Calcium channel blocker
§ Diuretics

It also include closely monitoring of blood pressure as

because there is an association between increased
diastolic blood pressure and aneurysm rupture.
vWATCHFUL WAITING
Not all thoracic aortic aneurysms need surgery.
If aneurysm is small, doctor may decide to wait
and watch carefully to see if there are any
changes. If patient have high blood pressure,
then doctor may prescribe medication to lower
it. If you smoke, your doctor may suggest that
you find help in quitting. If the doctor feels there
is a risk that the aneurysm will burst, he or she
may recommend one of two aneurysm repair
methods – either open surgical repair or
endovascular stent grafting
Open surgery is performed under
general anesthesia. Surgeon first makes
a incision Then, the aneurysm is
replaced with a fabric graft that is stich
into place. Patients typically spend one
night in an intensive care unit and then
remain in the hospital for 5 to 7 days.
An alternative to open surgery is called
endovascular stent grafting or endovascular
aneurysm repair (EVAR). Endovascular
stent grafting is a procedure in which a stent
graft such as Gore-Tex or PTEE material
reinforced with stents(Nitinol,
titanium).These endovascular graft inserted
into the thoracic aorta via various vascular
access routes, including the femoral or iliac
artery.
Ø Thoracic aneurysm
1.Watchful Waiting - Small AAAs (less than 5 centimeters or about
2 inches), which are not rapidly growing or causing symptoms, have
a low incidence of rupture and often require no treatment other
than watchful waiting under the guidance of a vascular disease
specialist. This typically includes follow-up ultrasound exams at
regular intervals to determine if the aneurysm has grown.

- The most common treatment for a large, unruptured aneurysm is

open surgical repair by a vascular surgery This procedure involves an incision from just
below the breastbone to the top of the pubic bone. The surgeon then clamps off the aorta,
cuts open the aneurysm and stich in a graft to act as a bridge for the blood flow. The
blood flow then goes through the plastic graft and no longer allows the direct pulsation
pressure of the blood to further expand the weak aorta wall.
 - Take history regarding disease
usually disease is asymptomatic and are found
incidentally. When the aorta enlarges and compresses
the surrounding structures, patient complaints may
include flank and back pain, epigastric discomfort,

of the patient with an intact abdominal

aneurysm usually reveals no significant findings.

Take history regarding sign and symptoms etc.

.

Improve cerebral tissue perfusion.

Monitor closely for

neurologic deterioration, and maintain a

neurologic flow record.
ü Check blood pressure, pulse, level of
consciousness, pupillary responses, and
motor function hourly; monitor respiratory
status and report changes immediately.
ü Implement aneurysm precautions
(immediate and absolute bed rest in a quiet,
nonstressful setting; restrict visitors, except
for family).
ü Elevate the head of bed 15 to 30 degrees or
as ordered.
ü Avoid any activity that suddenly increases
blood pressure or obstructs venous return
(eg, Valsalva maneuver, straining), instruct
patient to exhale during voiding or
defecation to decrease strain, eliminate
caffeine, administer all personal care, and
minimize external stimuli.
 Relief of anxiety.

1.Assess the level of anxiety

2.Explain all procedure in understandable language.
3.Provide all the knowledge about disease
4.Allow patient to express his fears and concerns about
diagnois.
5.Offer him and his family member about psychological
support

6.Instruct the patient about relaxation technique

 To minimize the risk for complication.

ü Assess for and immediately report signs of

possible vasospasm, which may occur several
days after surgery or on the initiation of
treatment (intensified headaches, decreased
level of responsiveness, or evidence of
aphasia or partial paralysis).

ü Maintain seizure precautions. Also maintain airway

and prevent injury if
a seizure occurs.Administer antiseizure medications as
prescribed (phenytoin [Dilantin] is medication of
choice).
ü Monitor for onset of symptoms of hydrocephalus,
which may be acute (first 24 hours after hemorrhage),
subacute (days later), or delayed (several weeks later).
Report symptoms immediately: acute hydrocephalus is
characterized by sudden stupor or coma; subacute or
delayed is characterized by gradual onset of
drowsiness, behavioral changes, and ataxic gait.
ü Monitor for and report symptoms of aneurysm
bleeding. Bleeding occurs most often in the first 2
weeks.
ü Symptoms include sudden severe headache, nausea,
vomiting, decreased level of consciousness, and
neurologic deficit.
ü Administer medications as order.
 Goal- To maintain adequate hydration level.

1. Watch closely for sign of any blood loss like decrease

blood loss, increase pulse rate and respiratory rate , cool
and calmy skin.
2. Assess the patient vital every 4 hourly or more
frequently ,depending on the severity of his condition.
3. Measure intake and output .
4. Monitor blood count to confirm blood loss reflected in
decreased haemoglobin level and red blood count.
 .

- To enhance activity tolerance.

ü Assess the level of activity tolerance and degree of

fatigue ,lethargy, and malaise when performing
ADL’s
ü Assist with activities and hygiene
ü Encourage rest when fatigued or when discomfort
occur.
ü Assist with selection and pacing of desired
activities and exercise.
ü Provide diet in high in protein intake consistency.
ü Administer supplemental vitamins(vit – A, C and
K)
 .

To enhance level of knowledge.

ü Asses the level of knowledge about disease

condition and treatment and management.
ü Provide explanation about disease condition
and its complication.
ü Assist patient to identify ways to incorporate
changes related to illness and its treatment.
Provide oral and written information
Bleeding
Hematoma
Wound infection
Ischemia
Embolization
Dissection
Perforation of aorta
Proximal or distal graft migration leaks
Delayed rupture
Bowel ischemia.