GRACIOUS COLLEGE OF NURSING

ABHANPUR (C.G)
TOPIC- Aneurism and peripherial vascular
disorders

PRESENTED BY –
OM VERMA
ASSISTANT PROFESSOR
DEFINITION
 An aneurysms is a localized sac or dilation
formed at a weak points in the wall of the
artery.
According to lippin cott

 Aneurysms is define as an excessive localized

swelling of the wall of an artery.
According to Lewis
 - Ananeurysm refers to a weakening of an
artery wall that creates a bulge, or
distention, of the artery. The most
significant aneurysms affect the arteries
supplying the brain and the heart. An
aortic aneurysm affects the body's main
artery. The rupture of an aneurysm causes
internal bleeding.
 According to Brunner & Suddarth's
 An aneurysm is a
permanent, localized,
abnormal dilation of a
blood vessel
Occurring due to
congenital or acquired
weakening or
destruction of the
vessel wall.
According to
Thomas Luckmann
Aneurysms are classified by three ways i.e

1).Depending upon the composition of wall.

2).Depending upon the shape.

3).Depending upon pathogenic mechanisms

Depending upon composition of vessel wall there are 2 types of
aneurysm i.e

1). TRUE ANEURYSM

when all the 3 normal layers of the blood vessel are
involved.
2). FALSE ANEURYSM –actually a pulsating hematoma the clot and
connective tissue are outside the arterial wall.
When only fibrous layer of the wall is involved and the
rest of the layers are damaged due to trauma.
There are 5 types i.e
1).spherical having spherical outpouching.

2).Fusiform -having spindle shape dilatation symmetric, spindle

shape expansion of entire circumference of involved vessel.
.
3).saccular aneurysm – a bulbous protrusion of one side of atrial
wall.
3)..Dissecting –it is a hematoma that splits the layer of atrial wall.

4).Racemose - having mass of intercommunicating small arteries

and veins.
1).Atherosclerotic aneurysms.

2).Syphilitic aneurysms.

3).Mycotic aneurysms.

4).Berry aneurysms.

5) Aortic aneurisms
Aneurysms can occur when the the structure and function of the connective tissue
within vascular wall is compromised, and it occurs in the following conditions
i.e.

1)Marfan syndrome.
2)Loeys_Dietz syndrome.
3)Ehler_Danlos syndrome.
4) Vitamin C deficiency
5)Increased MMP matrix metallo- proteinase
production by macrophages in vasculitis. inflammation in blood vessels
6)Ischemia of the media by athersclerotic
thickness of the intima and systemic
hypertension.
7)Direct trauma to the vessel.
 More common in men
 Frequency increases after 50 years of age.
 Most common in abdominal aorta especially other sites
include thoracic aorta, iliac arteries,
 Clinical features include,
 1.rupture
 2.Obstruction
 3.Embolism
 4.Abdominal mass
 More common in men after the age of 50 years.
 The predominant site of involvement is thoracic
aorta.
 Syphilitic aortitis is inflammation of the aorta
associated with the tertiary stage of
syphilis infection. SA begins as inflammation of
the outermost layer of the blood vessel, including
the blood vessels that supply the aorta itself with
blood, the vasa vasorum.
 (The vasa vasorum is a network of small blood
vessels that supply the walls of large blood vessels,
such as elastic arteries (e.g., the aorta)
1. Respiratory difficulties.
2. Difficulty in swallowing
3. Persistent cough due to pressure on recurrent
laryngeal nerve.
4. Pain caused by erosion of vertebral bodies.
5. Cardiac disease
6. Rupture
Usually death occurs due to cardiac diseases…….
It results from weakening of arterial wall by microbial
infection.
It originates from,
1. Embolization of a septic embolus as a complication
of infective endocarditis.
2. Extention of adjacent suppurative process.
3. Circulating organisms directly infecting the arterial
wall
Berry aneurysms are saccular
Or lobulated bulge arising at
the bifurcation of intracranial
arteries.

They are important cause of

Subarachnoid hemorrhage
And infarction .
ACCORDING TO JOYCE M. BLACK :
aortic aneurysm is a balloon-like bulge in
the aorta, the large artery that carries blood from
the heart
ACCORDING TO LUCKMEN :
An aortic aneurysm refers to an abnormal, localized
blood vessel wall weakness and bulging or ballooning (dilation)
in a segment of the aorta.
It is common in men of 40_60 yr age
With hypertension and young patients
with Connective tissue abnormalities.
PERIPHERAL VASCULAR DISEASE
 Peripheral vascular disease (PVD) is a blood
circulation disorder that causes the
blood vessels outside of your heart and brain to
narrow, block, or spasm. This can happen in arteries or
veins. PVD typically causes pain and fatigue, often in
legs, and especially during exercise
Peripheral vascular
disease (PVD) is a circulation
disorder that affects blood vessels
outside of the heart and brain,
often those that supply the arms
and legs.
PERIPHERAL VASCULAR
DISEASE

Types of peripheral
aneurysm
  PERIPHERAL ANEURYSM
 An aneurysm can also occur in a peripheral artery. Types of
peripheral aneurysm include:
 Popliteal aneurysm: This happens behind the knee. It is
the most common peripheral aneurysm.
 Splenic artery aneurysm: This type of aneurysm occurs
near the spleen. Filter of blood and remove old
malformed or damage res blood cells
 Mesenteric artery aneurysm: This affects the artery that
transports blood to the intestines.
 Femoral artery aneurysm: The femoral artery is in the
groin.
 Carotid artery aneurysm: This occurs in the neck.
 Visceral aneurysm: This is a bulge of the arteries that
supply blood to the bowel or kidneys.
ETIOLOGY
causes
 Smoking
 High blood pressure
 High cholesterol
 Obesity
 Having a family history of heart or vascular disease
 Defective gene
 Congenital disorder
 arthrosclerosis
 The most common causes of functional
PVD are:
 emotional stress
 cold temperatures
 operating vibrating machinery or tools
 drugs
 SMOKING
 smoking may cause the brain's blood
vessels to develop multiple aneurysms, or
weak spots. These weak spots can rupture
and cause bleeding that can lead to
stroke, disability, and death
 High blood pressure
 One potential cause is atherosclerosis,
which weakens and damages the artery
wall. Over time, high blood pressure in
a weakened artery can cause a section to
enlarge and form a bulge —
the aneurysm. Aneurysms can rupture
and causelife-threatening internal
bleeding.
 High cholesterol level
 H.C.L Lead to High blood
pressure; Infection; Plaque
buildup in your arteries ...
 OBESITY
Obesity. Excess weight, or a
diagnosis of obesity based on body
mass index (BMI), can put pressure
on the heart and the artery walls,
increasing the risk of ananeurysm.
 Family history

Having a family history of heart or

vascular disease
 DEFECTIVE GENS
 A defective gene. Researchers have found that people
who have a defect in one of 3 genes related to aortic
aneurysms have a greater chance of an aortic
dissection in their lifetime.
The FAA1 ( fatty acid activation ) gene
defect can be inherited in an autosomal
dominant fashion and result in aortic
dilatation, aneurysm formation and
dissection. Then lead to aneurysm.
 CONGENITAL
The causes of aneurysms are
sometimes unknown. Some may be
congenital, meaning a person is
born with them. Aortic disease or
an injury may also cause an
aneurysm.
 ATHEROSCLEROSIS
 percent of aortic aneurysms are
caused by "hardening of the arteries"
(atherosclerosis). ... Over time, this
causes the walls of the aorta to weaken
and become damaged. Elevated blood
pressure through the aorta can
then cause the aortic wall to expand
and bulge.
 Peripheral Vascular Disease Symptoms
 Buttock pain.
 Numbness, tingling, or weakness in the legs.
 Burning or aching pain in the feet or toes while resting.
 A sore on a leg or a foot that will not heal.
 One or both legs or feet feeling cold or changing color (pale,
bluish, dark reddish)
 Loss of hair on the legs.
 . Impotence is a common problem among men and is
characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to
achieve ejaculation, or both. Erectile dysfunction can vary.
Severe headache
Transient ischemia
Seizures
Oculomotor nerve palsy or
vision loss
Chronic loss of vision
Facial pain
 Common signs and symptoms of a
ruptured aneurysm include:
 Sudden, extremely severe headache.
 Nausea and vomiting.
 Stiff neck.
 Blurred or double vision.
 Sensitivity to light.
 Seizure.
 A drooping eyelid.
 Loss of consciousness.
 PATHOPHYSIOLOGY
Aneurysms form for a variety of interacting reasons.
Multiple factors, including factors affecting a blood
vessel wall and the blood through the vessel, contribute.
 The pressure of blood within the expanding
aneurysm
may also injure the blood vessels supplying the
artery itself,

further weakening the vessel wall.

Without treatment, these aneurysms will ultimately
progress and rupture

Then lead aneurysms.

 DIAGNOSITIC
 Stress testing shows how heart works during
physical stress (exercise) and how healthy heart
is. A standard exercise stress test uses an ECG
(electrocardiogram) electrodes are taped to your
chest to detect your heart's rhythm. A nurse or
technician will watch your heart beat on a monitor
while you exercise. to monitor changes in your
heart's electrical activity. Imagingstress tests take
pictures of blood flow artery of heart.
computed tomography
angiography scan (also called a CTA
scan) – a diagnostic imaging procedure that
uses a combination of x-rays and computer
technology to produce cross-sectional images
(often called slices), both horizontally and
vertically, of the body. A CT scan shows
detailed images of any part of the body,
including the bones, muscles, fat, and organs.
CT scans are more detailed than standard x-
rays.
magnetic resonance imaging
and angiography (MRI/MRA) – a
diagnostic procedure that uses a
combination of large magnets,
radiofrequencies, and a computer
to produce detailed images of
organs and structures within the
body.
arteriogram (angiogram) – an
x-ray image of the blood vessels used to
evaluate various conditions, such as
aneurysm, stenosis (narrowing of the
blood vessel), or blockages. A dye
(contrast) will be injected through a
thin flexible tube placed in an artery.
This dye will make the blood vessels
visible on the x-ray.
MANAGEMENT
MEDICAL MANAGEMENT
 TO identification of causative agents
 Eating a healthy diet containing low in saturated fat and
cholesterol are also good options for protein. Low-fat dairy
products are also beneficial.
 Regular exercise, especially cardio, can encourage healthy
blood circulation and blood flow through the heart,
arteries, and other blood vessels.
 If you smoke tobacco products, now is the time to quit.
Eliminating tobacco can decrease your risk for an
aneurysm.
 You should also see your doctor for annual checkups.
PHARMACOLOGICAL
MANAGEMENT
 Pain relievers, such as acetaminophen
(Tylenol, others), may be used to treat
headache pain. Calcium channel blockers
prevent calcium from entering cells of the
blood vessel walls.
 PHARMACHOLOGICAL
 ANTI HYPERTENSIVE DRUG
 ANTI COAGULANT
 Pain relievers, such as acetaminophen (Tylenol, others), may be used
to treat headache pain.
 Calcium channel blockers prevent calcium from entering cells of the
blood vessel walls. These medications may lessen the erratic narrowing
of blood vessels (vasospasm) that may be a complication of a ruptured
aneurysm.
 One of these medications, nimodipine (Nymalize, Nimotop), has been
shown to reduce the risk of delayed brain injury caused by insufficient
blood flow after subarachnoid hemorrhage from a ruptured aneurysm.
 Interventions to prevent stroke from insufficient blood
flow include intravenous injections of a drug called a vasopressor,
which elevates blood pressure to overcome the resistance of narrowed
blood vessels.
 An alternative intervention to prevent stroke is angioplasty. In this
procedure, a surgeon uses a catheter to inflate a tiny balloon that
expands a narrowed blood vessel in the brain. A drug known as a
vasodilator also may be used to expand blood vessels in the affected
area.
Anti-seizure medications may be used to treat
seizures related to a ruptured aneurysm. These
medications include levetiracetam (Keppra),
phenytoin (Dilantin, Phenytek, others), valproic acid
(Depakene) and others. Their use has been debated
by several experts, and is generally subject to
caregiver discretion, based on the medical needs of
each patient.
Rehabilitative therapy. Damage to the brain from a
subarachnoid hemorrhage may result in the need for
physical, speech and occupational therapy to relearn
skills.
SURGICAL MANAGEMENT
 Ventricular or lumbar draining catheters and shunt
surgery can lessen pressure on the brain from excess
cerebrospinal fluid (hydrocephalus) associated with a
ruptured aneurysm. A catheter may be placed in the
spaces filled with fluid inside of the brain (ventricles) or
surrounding your brain and spinal cord to drain the
excess fluid into an external bag.
 Sometimes it may then be necessary to introduce a shunt
system — which consists of a flexible silicone rubber
tube (shunt) and a valve — that creates a drainage
channel starting in your brain and ending in your
abdominal cavity.
endovascular coiling
 Endovascular coiling is a minimally
invasive technique, which means an
incision in the skull is not required to
treat the brain aneurysm. Rather, a
catheter is used to reach the aneurysm in
the brain. During endovascular coiling,
a catheter is passed through the groin up
into the artery containing the aneurysm.
Endovascular surgery
is performed inside your aorta using
thin, long tubes called catheters to
place a stent surrounded with a fabric
liner to reinforce the weak spots. You
may be eligible for endovascular stent
grafting if your aneurysm has not
ruptured and the aneurysm is 5
centimeters or more in size.
 COMPLICATION
 If the pressure becomes too elevated,
the blood and oxygen supply to the
brain may be disrupted to the point
that loss of consciousness or even
death may occur.Complications that
can develop after the rupture of
an aneurysm include: Re-bleeding.
An aneurysm that has ruptured or
leaked is at risk of bleeding again.
 Re-bleeding. An aneurysm that has ruptured or leaked is at
risk of bleeding again. ...
 Vasospasm. After a brain aneurysm ruptures, blood vessels in
your brain may narrow erratically (vasospasm). ...

 Hydrocephalus . .. Hydrocephalus is a condition in which

an accumulation of cerebrospinal fluid (CSF) occurs within the
brain. This typically causes increased pressure inside the skull.
Older people may have headaches, double vision, poor balance,
urinary incontinence, personality changes, or mental
impairment..
 Hyponatremia. Hyponatremia is a low sodium
concentration in the blood