1. AORTIC ANEURYSM Prepared by: Dr. Hanan Said Ali

2. Objectives Define aortic aneurysm. Enumerate causes. Classify aortic aneurysm. Enumerate clinical manifestation. Identify diagnostic studies of the disease. Identify principles of care. Describe how to manage aortic aneurysm.

3. AORTIC ANEURYSM Definition An aneurysm is defined as a localized dilation of the aorta to a size greater than 1.5 times its normal diameter.

4. AORTIC ANEURYSM Causes Arteriosclerotic. Infection. Inflammatory diseases. Traumatic aneurysms. Hypertension. History of smoking.

5. AORTIC ANEURYSM Classification according to shape Fusiform Are diffuse dilations of the entire circumference of the artery. Saccular Are localized balloon- shaped outpouchings. A False aneurysms Is formed when blood leaks outside of the artery but is contained by the surrounding tissues.

6. Saccular true aneurysmFusiform true aneurysmFalse aneurysm

7. AORTIC ANEURYSM Aneurysms may be: thoracic abdominal

8. AORTIC ANEURYSM Assessment ( Signs and Symptoms) Pain: a tearing pain of abrupt onset in the chest or upper abdomen radiating through to the back. Neurological symptoms: Syncope, headache, stroke, or paraplegia. Pulse: One or more of the major pulses may be absent or a symmetric.

9. AORTIC ANEURYSM Assessment ( Signs and Symptoms) Signs of acute aortic incompetence may be present if the ascending aorta is involved. Angina may be present due to occlusion of the origins of one or more coronary arteries.

10. AORTIC ANEURYSM Physiological assessment: Blood pressure: There may be a discrepancy in systolic pressure between right and left arms of more than 15 mmHg

11. AORTIC ANEURYSM Investigations Chest X- ray may reveal midiastinal widening. ECG is usually unremarkable, although ischemic changes may be present. Transesophageal Echocardiography. CT scan or angiography.

12. AORTIC ANEURYSM Management Treatment for aneurysms involves surgical repair, which is usually indicated in aneurysms larger than 5 cm. In addition to surgery, abdominal aneurysms may be repaired by a minimally invasive approach using an endovascular graft.

13. AORTIC ANEURYSM Management Cont. This approach involves placement of a graft through the femoral artery. The graft is then anchored the wall of the aorta by means of balloon expanded stents.

14. Priorities of care Urgent resuscitation if there is cardiovascular compromise, including immediate transfer to the operating theatre if necessary. Pain relief (opiates are usually given) High- flow, high- concentration oxygen. If hypertensive, blood pressure should be reduced using an infusion of either sodium nitroprusside with the aim of reducing systolic BP to below 100 mmHg if possible

15. Principles of care Arterial cannula- for continuous blood pressure monitoring. Bladder catheter- measure urine output. ( Oliguria suggests that the lowering of blood pressure may be excessive while anuria is suggestive of aneurysmal involvement of the renal arteries. It is important to reassure the patient and prevent unnecessary agitation.

16. Nursing Management Assess Signs of impending rupture include: severe back pain because of pressure of the aneurysm on the lumbar nerves. abdominal pain, which may be persistent or intermittent and is often localized in the middle or lower abdomen to the left of the midline

17. Nursing Management Cont. Postoperative care requires: intense monitoring of pulmonary, cardiovascular, renal, and neurologic status. Asses possible complications of surgery include: arterial occlusion, haemorrhage, infection, ischemic bowel, renal failure, and impotence

18. Thank You