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ANEURYSM (Central aneurysms
(AAA &TAA) (Pathophysiology:
*Risk…
ANEURYSM
-
Aortic Dissection
Classifications:
Anatomical Position: Ascending v Descending Aorta
Duration: Acute v Chronic
approximately two-thirds of dissections involve the ascending aorta and are acute in onset
Pathophysiology
Tear inner layer of aorta
Blood surges into the middle layer
inner and middle layers to separate
Etiology/Risk Factors
• Degenerated elastic fibers in the arterial wall
• Chronic Hypertension hastens this process
• Inherited/Acquired connective tissue disorders causing abnormal vascular ECM
• Blunt trauma
• Cocaine/methamphetamine use
• History of heart surgery
• Atherosclerosis
• Male gender
• Pregnancy
Incidence
Affects men 2-5 times more often than women and occurs more frequently in the 6th and 7th decades of life
Manifestations:
Acute Ascending:
• Abrupt onset of excruciating chest and/or back pain radiating to the neck or shoulders
Acute Descending:
• Pain located in the back, abdomen or legs
• Pain is frequently described as "sharp" and "worst ever," or as "tearing," "ripping" or "stabbing"
• Neurologic deficits
• May develop angina
• Abdominal Organs & Lower Extremities = decreased tissued perfusion
Complication:
• Cardiac Tamponade
• Aortic rupture
Hemorrhage
Occlusion of blood supply to vital organs
Collaborative Care
Diagnostic
ECG, Chest X-ray, CT scan with 3-D Reconstruction, Transesophageal echocardiogram, MRI
Collaborative Therapy
Bed Rest
Pain relief: opioids
Blood Transfusion (If necessary)
Drug Therapy:
IV B-adrenergic blockers
IV Calcium channel blockers
ACE inhibitors
Surgical aortic resection and repair
Endovascular aortic dissection repiar
Peripheral aneurysms
Femoral and popliteal aneurysms: are not common. Are often associated with aneurysms in other locations.
• Observe for a pulsating mass over the femoral artery. Assess for a pulsating mass in the popliteal space. Evaluate both extremities.
• S/S: limb ischemia, diminished or absent pulses, cool-cold skin, pain.
• Regardless of size surgery is recommended because of the risk of clots.
• Palpate pulses below the graft to assess graft patency. Report sudden development of pain.