Modifiable Factors

- Cigarette smoking
- Atherosclerosis
- Trauma
- Hypertension
- Arteritis
- Obesity
- Presence of bicuspid aortic valve
Non Modifiable Factors
- Age (60 )
- Gender (Male)
- Genetics
Accumulation of lipids, fibrin, debris, cholesterol crystals
Plaque formation
Atherosclerosis
Ulcerate (brake Open)
Degenerative changes
Damaged endothelial lining
Loses elasticity & becomes weak
Dilation of Aorta
Development of thrombus
Narrows the vessel
Swept along by blood
Emboli
Aortic Aneurysm
An aortic aneurysm is an abnormal enlargement or bulging of the wall of the aorta. An aneurysm can
occur anywhere in the vascular tree. The bulge or ballooning may be defined as a:
y Fusiform: Uniform in shape, appearing equally along an extended section and edges of the aorta.
y Saccular aneurysm: Small, lop-sided blister on one side of the aorta that forms in a weakened
area of the aorta wall.

History
The first historical records about AAA are from Ancient Rome in the 2nd century AD, when Greek
surgeon Antyllus tried to treat the AAA with proximal and distal ligature, central incision and removal of
thrombotic material from the aneurysm.
However, attempts to treat the AAA surgically were unsuccessful until 1923. In that year, Rudolph Matas
(who also proposed the concept of endoaneurysmorrhaphy), performed the first successful aortic ligation
on a human.
Other methods that were successful in treating the AAA included wrapping the aorta with polyethene
cellophane, which induced fibrosis and restricted the growth of the aneurysm.
Albert Einstein was operated on by Rudolf Nissen with use of this technique in 1949, and survived five
years after the operation. Endovascular aneurysm repair was first performed in the late 1980s and has
been widely adopted in the subsequent decades.
AAA is uncommon in individuals of African, Asian, and Hispanic heritage.
There are 15,000 deaths yearly in the U.S. secondary to AAA rupture. The frequency varies strongly
between males and females. The peak incidence is among males around 70 years of age, the prevalence
among males over 60 years totals 2-6%.
The frequency is much higher in smokers than in non-smokers (8:1), and the risk decreases slowly after
smoking cessation. Other risk factors include hypertension and male sex. In the U.S., the incidence of
AAA is 2-4% in the adult population.. AAA is 4-6 times more common in male siblings of known
patients, with a risk of 20-30%.
Rupture of the AAA occurs in 1-3% of men aged 65 or more, the mortality is 70-95%.


Classification
Thoracic aortic aneurysms are found on the thoracic aorta; these are further classified
as ascending, aortic arch, or descendinganeurysms depending on the location on the thoracic aorta
involved.
Abdominal aortic aneurysms, the most common form of aortic aneurysm, are found on
the abdominal aorta, and thoracoabdominal aortic aneurysms involve both the thoracic and
abdominal aorta.
Popliteal: an aneurysm in the artery behind the knee
Renal: an aneurysm in the kidney; a very rare condition
Visceral: an aneurysm in an internal organ and/or intestines

Etiology
Congenital: primary connective tissue disorders (Marfans syndrome, Ehlers- Danlos syndrome) and
other diseases (focal medical agenesis, tuberous sclerosis, Turnersr syndrome, Menkes syndrome)
Mechanical (hemodynamic): Poststenotic and arteriovenous fistula and amputation related.
Traumatic (pseudoaneurysms): Penetrating arterial injuries, blunt arterial injuries
Inflammatory (noninfectious): Associated with arteritis (Takayasus dse, giant cell arteritis, SLE,
Behcets syndrome, Kawasakis dse) and periarterial inflammation (i.e pancreatitis)
Infectious (mycotic): Bacterial, Fungal, Spirochetal infections
Pregnancy related degenerative: Nonspecific, inflammatory variant
Anastomotic (postartetiotomy) and graft aneurysms: infection, arterial wall failure, suture failure,
graft failure







Manifestations
Symptoms of a thoracic aortic aneurysm (affecting upper part of aorta in chest):
y Pain in the jaw, neck, upper back or chest
y Coughing, hoarseness or difficulty breathing, stridor, aphonia, dysphagia
Symptoms of an abdominal aortic aneurysm (affecting lower part of aorta in abdomen):
y Pulsating enlargement or tender mass felt by a physician when performing a physical examination
y Pain in the back, abdomen, or groin not relieved with position change or pain medication

Diagnostics
y Chest x-ray
y Computed tomography (CT) scan
y Magnetic resonance imaging (MRI)
y Echocardiography (an ultrasound of the heart) / TEE
y Abdominal ultrasound (to look for associated abdominal aneurysms)
y Angiography (an x-ray of the blood vessels)
Treatment
Medical
Statin (or cholesterol lowering medication) to maintain the health of your blood vessels.
Controlling BP (systolic pressure maintained at 100 120 mmHg)
Antihypertensive : hydralazine (Apresoline)
Beta blocker : esmolol (Brevibloc), metoprolol (Lopressor)
IV drip: Sodium nitroprusside (Nipride)
watchful waiting. By closely monitoring your condition with CT or MRI scans every 6-12
months, the aneurysm will be watched for signs of changes.
Surgical
Endovascular graft
Endovascular repair
endoluminal exclusion

Nursing Care
1. Ineffective health maintenance
Interventions:
a. Assess level of clients cognitive, emotional, physical functioning.
b. Note clients age
c. Note desire/ level of ability to meet health maintenance needs, as well as self-care ADLs.
d. Assess clients ability and desire to learn.
e. Encourage socialization and personal involvement
f. Assist client to develop stress management skills

2. Fear/Anxiety related to lack of understanding of diagnostic tests, surgical
procedure, and postoperative care.
Interventions:
g. Orient client to critical care unit if appropriate.
h. Describe and explain the rationale for equipment and tubes that may present
postoperatively. (e.g., cardiac monitor, ventilator, intravenous and intra-arterial lines,
NGT, urinary catheter)
i. Reinforce physicians explanations and clarify misconceptions client has about effects of
the surgery on sexual functioning

3. Risk for imbalanced fluids and electrolytes
Interventions:
a. Note potential sources of fluid loss/intake.
b. Note clients age, current level of hydration, and mentation.
c. Review laboratory data
d. Measure and record intake and output.
e. Weigh daily
f. Auscultate BP, calculate pulse pressure. (pulse pressure widens before systolic BP drops
in response to fluid loss.)