- Is the distention of an artery caused by structural weakening of the arterial wall. Under hemodynamic pressure, the weakened area enlarges, causing serious complications by compressing surrounding structures.
- It result from degeneration of the medial wall, which occurs as a normal part of the aging process as well as with hypertension, atherosclerosis, trauma or infection, immunologic conditions, and as a complication of Marfan Syndrome.
- Thoracoabdominal aortic aneurysm may originate in the ascending aorta and aortic arch (frequent site of dissection) or in the lower descending thoracic aorta and upper abdominal aorta.
- Abdominal aneurysms originate in the abdominal aorta, typically between the renal arteries and iliac branches. Most of the male patients are asymptomatic.
- Complications includes fatal hemorrhage, paraplegia caused by interruption of anterior spinal artery, abdominal ischemia stroke, myocardial ischemia, lower extremity ischemia, renal failure, impotence, and cardiac tamponade.
- Constant, boring pain or pressure in chest.
- Intermittent neuralgic pain caused by nerve compression.
- Dyspnea, cough, and hoarseness because of pressure against trachea and recurrent laryngeal nerve.
- Dysphagia because of pressure on esophagus.
- Dilated superficial veins of chest and cyanosis caused by compression of chest vessels.
- Ipsilateral dilation of pupils caused by pressure against cervical sympathetic chain.
- Pulse or blood pressure variations between arms caused by interference with circulation in left subclavian artery.
2. Abdominal Aneurysm
- Persistent or intermittent abdominal pain, often localized to middle or lower left side of abdomen.
- Pulsating mass with bruit.
- Blood pressure elevated in arm more than in thigh.
3. Predisposing factors
- Local infection, pyogenic or fungal (mycotic aneurysm)
- Congenital weakness of vessels
- Abdominal or chest X-rays may show calcification that outlines the aneurysm.
- CT scan and ultrasonography are used to detect and monitor size of aneurysm.
- MRI or magnetic resonance angiography further evaluate circulation.
- Arteriography allows visualization of aneurysm and vessel.
- Surgery may be required to remove the aneurysm and restore vascular continuity with a bypass graft. Complications of surgery include arterial occlusion, graft hemorrhage, infection, ischemic colon, and impotence.
- Endovascular grafting using stent inserted via catheter through the femoral artery may be warranted.
- Monitor for signs and symptoms of spinal cord ischemia such as pain, numbness, paresthesia, and weakness caused by dissection.
- Monitor for signs of stroke or cardiac tamponade caused by dissection.
- Postoperatively, monitor vital signs continuously.
- Check extremities for sensation, temperature, pulses, color, capillary refill, and petechiae.
- Monitor for bleeding from the wound and for signs of hemorrhage, hypotension, tachycardia, pallor, and diaphoresis.
- Monitor temperature and incision for signs of infection.
- Monitor urinary output hourly.
- Administer antibiotics, if ordered, to prevent infection.
- Administer pain medication, as ordered, or monitor patient-controlled analgesia.
- Elevate the head of the bed no more than 45 degrees for first 3 days postoperatively to prevent pressure on the repair graft site.
- Warn patient not to cross legs or sit for long periods to prevent thrombus formation.
- Teach the patient about blood pressure medications and the importance of taking them as prescribed.
- Teach the patient to recognize and report signs and symptoms of an expanding aneurysm or rupture.
- Encourage adequate nutritional intake to enhance wound healing.
- Teach the patient to maintain a postoperative exercise regimen.