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Peripheral Vascular Disorder: Aneurysm - Coggle Diagram
Peripheral Vascular Disorder: Aneurysm
Definition
Abnormal dilatation of a blood vessel, commonly at a site of the blood vessel due to weakness or a tear in the vessel wall
Often asymptomatic but can result in severe complications, such as rupture and bleeding, causing life-threatening due to
internal haemorrhage
Types
Cerebral aneurysm
Occurs in the artery in the brain
Others
Occurs in the artery in the brain
Aortic aneurysm
Abdominal aortic aneurysm (AAA)
Thoracic aortic aneurysm
Characteristics/Forms of Aneurysm
False Aneurysm
Pulsating hematoma; Clot and connective tissue outside arterial wall
Aortic Dissection/Dissecting Aneurysm
Hematoma that splits layers of the arterial wall
True Aneurysm
1, 2 or all 3 layers may be involved
Fusiform aneurysm
Symmetric, spindle shaped expansion of entire circumference of involved vessel
Saccular aneurysm
Bulbous protrusion of one side of the arterial wall
Pathophysiology
Risk Factors
Age
Older adults are at higher risk - after 65 years, as blood vessels become less elastic
Family History
A family history of aneurysms increases the risk due to genetic factors
Atherosclerosis
Fatty buildup in the arteries can damage vessel walls
Smoking
Smoking damages blood vessels and increases risk - aorta
High Blood Pressure
It can weaken blood vessels over time -making more likely to bulge or rupture
Genetic Condition
Conditions like Marfan syndrome make blood vessels weaker
Injury
Physical damage to blood vessels can cause aneurysms
Infections
Certain infections can weaken blood vessels
Male Gender
Men are more likely to develop aneurysms - aortic aneurysms
High Cholesterol
It can lead to plaque buildup in arteries, damaging blood vessels
Etiologic Classification
Inflammatory (Non-infection)
Associated with arteritis i.e. SLE, Kawasaki disease and periarterial i.e. pancreatitis
Infectious (mycotic)
Bacterial, fungal
Traumatic (Pseudo Aneurysm)
Penetrating & blunt arterial injuries, pseudoaneurysm
Pregnancy - related degenerative
Non-specific, inflammatory variant
Mechanical (Hemodynamic)
Post stenotic, arteriovenous fistula and amputation related
Anastomotic (post arteriotomy) and graftaneurysms
Infection, arterial wall failure, suture failure, graft failure
Congenital
Primary connective tissue disorders i.e. Marfan’s (abnormality various organs and tissues)- disease-heart valve abnormalities. Turner’s syndrome( Chromosome) - Higher risk of congenital heart defects or Menke’s syndrome(lead to a range of development)-risk of congenital heart defects
Clinical Manifestation
Thoracic Anuerysm
Dyspnoea, stridor, or brassy cough if press on trachea
Hoarseness and dysphagia if press on oesophagus or laryngeal nerve
Back, neck or substernal pain
Oedema of the face and neck; Distended neck veins
Maybe asymptomatic
Abdominal Aortic Anuerysm (AAA)
Mild to severe mid abdominal or lumbar back pain
Cool, cyanotic extremities if iliac arteries involved
Claudication – ischemic pain with exercise, relieved by rest
Aortic calcification on x-ray
Pulsating abdominal mass
Aortic Dissection
Mild or moderate hypertension early
Weak or absent pulses and BP in upper extremities; Syncope
Abrupt, severe, ripping or tearing pain in area of aneurysm
Clinical Manifestations
Aortic dissection may be mistaken for an acute myocardial infarction, which could confuse the clinical picture and initial treatment
Cardiovascular, neurologic, and gastrointestinal symptoms are responsible for other clinical manifestations, depending on the location and extent of the dissection
The pain is in the anterior chest or back and extends to shoulders, epigastric area, or abdomen
The patient may appear pale
Severe and persistent pain, described as tearing or ripping, may be reported
Sweating and tachycardia may be detected. Blood pressure may be elevated or markedly different from one arm to the other if dissection involves the orifice of the subclavian artery
Diagnosis
Trans oesophageal echocardiography
To identify the specific location and extent of a thoracic aneurysm
To visualise a dissecting aneurysm
Contrast-enhanced CT or MRI
To allow a precise measurement of aneurysm size
Abdominal ultrasonography
To diagnose AAA
Angiography
Uses contrast solution injected into aorta or involved vessel to visualise the precise size and location of the aneurysm
CXR
To visualise thoracic aortic aneurysm
Medical Management
Thoracic Aortic Aneurysm
Long term beta blockers and antihypertensive to control HR & BP
Aortic Dissection
IVI Sodium Nitroprusside (Nipride) to ↓ systolic to 120mmHg
Calcium channel blockers i.e. verapramil, dilthiazem
Avoid direct vasodilators i.e. diazoxide (Hyperstat) hydralazine (Apresoline)
Initially with IV beta blockers i.e. propranolol (Inderal), metoprolol (Lopressor) or esmolol (Brevibloc) to ↓HR to 60bpm
Anticoagulant i.e. heparin s/c to per oral post-surgery
Surgical Management
Open surgery repair
Involves removal of the dilated abdominal aorta and replacing it
with a prosthesis made of synthetic material/ graft that is sutured into place
Blood can flow normally through it and the artery wall is used to cover the graft
Endovascular stent graft (ESVG)
Placement of a stent-graft device through femoral artery into the
area of the aneurysm, the stent-graft is unfolded and expanded with a balloon
This type of graft is not sewn into place. To allow blood to flow through the graft
Cerebral Aneurysm
Clipping
Craniotomy performed followed by placement of a tiny clip across the neck of the aneurysm to stop or prevent it from bleeding
Coiling
Procedure to insert platinum coils into an aneurysm; performed during an angiogram
Pre & Post Operative Care
Post Operative Care
Nursing Management for Post Endovascular Repair