outpouching or dilations of the arterial wall

common problems involving aorta

occur in men more often than women

incidence increases with age

trauma (MVA)

infection

athersclerosis/HTN

after peripheral artery bypass graft surgery at site of anastomosis

often asymptomatic

most common manifestations:

deep difffuse chest pain or back pain

SOB/hoarseness/dysphagia

hypovolemic shock

distended neck veins

edema

often asymptomatic

frequently detected when patient examined for unrelated problem

pulsatile mass in periumbilica area

bruit may be auscultated

"gnawing" back/flank/abdominal pain

goal- prevent aneurysm from rupturing

early detection/treatment imperative

once detected studies are done to determine size and location

Small Aneurysm (<4cm)

conservative therapy used

risk factor modification

decrease BP/DM/athersclerosis

ultrasound, MRI, CT scan monitoring q6months

5.5cm is threshold for repair

Emergent surgical intervention required for ruptured aneurysms

AAA resections-

require cross claming of aorta proximal and sital to aneurysm

can be completed in 30-45 minutes

clamps are removed and blood flow to lower extremities restored

decreased anesthesia and operative time

smaller operative blood loss

decreased morbidity and mortality

more rapid resumption of physical activity

shortened hospital stay

quicker recovery

higher patient satisfaction

reduction in overall costs

aneurysm growth

aneurysm rupture

perigraft leaks

aortic dissection

bleeding

graft dislocation and embolization

graft thrombosis

incisional site hematoma

site infection

pre-op care

establish baseline data to compare postoperatively

watch for signs of cardiac, pulmonary, cerebral, lower extremity vascular problems

Watch for Post-op:

MI

Graft-occlusion or rupture

RF-hypovolemia

respiratory distress

paralytic ileus

diaphoresis/paleness/cool LE

weakness/tachycardia

hypotension

decrease urine output

abdominal, back, groin, or periumbilical pain

changes in level of consciousness

pulsating abdominal mass

peripheral pulses

normal tissue perfusion

intact motor and sensory fxn

no complications related to surgical repair

maintain graft patency

cardiovascular status

infection

GI status

peripheral perfusion status

renal perfusion status

encourage pt to express concerns

pt instructed to gradually increase activities

no heavy lifiting

educate on signs and symptoms of complications (infection, NV changes)

patent arterial graft with adequate distal perfusion

*adequate urine output

normal body temperature

no signs of infection

s/sx depend on location of intimal tear and extent of dissection

pain characterized as:

sudden, severe pain, in anterior part of chest or intrascapular pain radiating down spine to abdomen or legs

described as tearing or ripping or stabbing

may mimic that of MI

Severe, life threatening complication

occurs when blood escapes from dissection into pericardial sac

Clinical manifestations include:

hypotension

narrowed pulse pressure

distending neck veins

muffled heart sounds

pulsus paradoxus

decrease BP and myocardial contractility to diminish pulsatile forces within aorta

elimination of pain

Therapeutic Regimen (antihypertensive drugs and side effects)

if pain returns or symptoms progress, instruct patient to seek immediate help