ABDOMINAL

AORTIC
ANEURISM
Presented by: Jerome
L. Lumanog
WHAT IS AN ANEURISM
●It is an excessive localized enlargement of an
artery caused by weakness in the arterial wall.
ABDOMINAL AORTIC ANEURYSM
ABDOMINAL AORTIC ANEURYSM
● occurs when an area of the aorta becomes very
large or balloons out.
● This disorder is conventionally diagnosed if the
aortic diameter is 30 mm or more (Normal: 16-
22 mm)
● This also occurs when there is an increase in size
of vessel 1 and half times normal diameter
EPIDEMIOLOGY
● The prevalence of abdominal aortic aneurysm
(AAA) is 4 to 8 percent
●  Age significantly impacts the incidence.
● The annual incidence of new AAA diagnoses is
approximately 0.4 to 0.67 percent in Western
populations
● 8.2 percent and 1.7 percent in men and 2.3 percent
and 0.4 percent in women
Diagnosis
●Abdominal ultrasound
●Abdominal CT scan
●Abdominal MRI.
●Plain Radiography
●Palpitation (Pulsating mass in the
middle of the abdomen)
TREATMENT

●Medical Therapy
●Open Repair
●Endovascular aneurysm repair
Medical Therapy
●Cessation of smoking
●Risk factor reduction
●Beta Blockers
●Antibiotic Therapy (Roxithromycin)
Open Repair Surgery
● An open surgery in the abdomen to see
and work on the aorta. Large incision
in the abdomen to expose the aorta
● uses a man-made tube (called a graft)
to replace the weak and bulging
section of the aorta in the belly
Open Surgery
Risks
• Heart attack
• Irregular heart rhythms
• Bleeding during or after surgery
• Injury to the bowel
• Loss of blood flow to legs or feet from a blood clot
• Blood clot
• Infection of the graft
• Lung problems
• Kidney damage
• Spinal cord injury
Endovascular aneurysm repair (EVAR)

●minimally invasive option

●repairs the aneurysm from the
inside of the damaged blood
vessel (the aorta).
Risk factors
• Damage to surrounding blood vessels, organs, or other structures
• Kidney damage
• Loss of blood flow to leg or feet from a blood clot
• Groin wound infection
• Groin hematoma (large blood-filled bruise)
• Bleeding
• Endoleak (continual leaking of blood out of the graft and into the
aneurysm sac with potential rupture)
• Spinal cord injury
Nursing Diagnosis
●Abdominal aortic aneurysm
●Anxiety from pain
●The decreased cardiac output
from rupture
●Shock if a rupture has occurred
Nursing Management
● Check by palpation for a pulsating mass in the
abdomen, at or above the umbilicus.
● Auscultate for a bruit over the abdominal aorta.
● Determine if there is tenderness on palpation (do
not palpate too deep as there is a risk of rupture).
● Ask if the patient has abdominal or lower back pain.
● Check blood pressure to determine if a rupture has
occur.
Nursing Management
● Check distal leg pulses to ensure tissue
perfusion.
● Strict blood pressure control if high (may
need oral or IV medications).
● Ensure that the patient has been seen by
anesthesia and the vascular surge
PATHOPHYSIOLOGY
LEGEND
PATHOPHYSIOLOGY

MECHANISM

SIGNS AND
SYMPTOMS

COMPLICATIONS

FACTORS

LABS
FACTORS
 AAA=abnormal irreversible
dilation of a focal area of
abdominal aorta (twice in
diameter of adjacent normal
artery segments)

Asymptomatic, AAAs are at risk for rupture

non-ruptured Symptomatic, non-ruptured
(risk ↑ with ↑ size of aneurysm
aneurysm
aneurysm

Detectable only in Ruptured AAA: medical

imaging or by emergency
palpitation

 ultrasonography
(US)
 plain
radiography
 computed
tomography
(CT)
 magnetic
resonance
imaging
(MRI)
angiography
 Symptomatic, non-ruptured
aneurysm

Adventitia may dilate Stagnant blood flow

significantly prior to within AAA allows
rupture blood & clotting
factors to accumulate
(Very rare 0.1%)

Nociceptors are
activated by adventitia
dilatation Blood clots develop
(thrombi)

Abdominal and/or back

Thrombi may dislodge
pain
and travel to distal
vasculature cutting of
blood flow

 Kidney
Ischemia
 Lower Limb
Ischemia
 Ruptured AAA: medical
emergency

Aorta lies in between the peritoneal and

retroperitoneal space

Posterior aortic Sudden and Severe Anterior aortic

wall rupture abdominal and/or back wall rupture
pain

Retroperitoneal Peritoneal
Hemorrhage Hemorrhage
 Retroperitoneal Peritoneal
Hemorrhage Hemorrhage

↓ Space for blood to Massive Hemorrhage Peritoneal space is larger

accumulate in the due to high blood and holds larger volumes
retroperitoneal space flow volume through of blood
aorta

Rapid Pressure ↑ in
retroperitoneal space Hypertension and Entire blood volume can
overcomes the pressure in aorta rapid progression to pool in the peritoneal space
hypovolemic shock

Pressure gradient prevents

further blood loss from ruptured
DEATH
aorta
 Pressure gradient prevents
further blood loss from ruptured
aorta

Tamponade prevents
catastrophic blood loss

Compensated Hypovolemic low blood pressure

shock: is now
(inappropriately) ↑ blood pressure
 Low blood pressure
treated with fluid
 Poor organ perfusion resuscitation

Bleeding into Differential Pressure

retroperitoneal space gradient is reversed
resumes

Decompensation of POSSIBLE DEATH

hypovolemic shock
 Sources
● Shaw, P., Loree, J., Gibbons, R., & McCoy, T. (2021). Abdominal Aortic Aneurysm
(Nursing). Retrieved 19 September 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK568681/
● abdominal Aortic Aneurysm Repair. (2021). Retrieved 19 September 2021, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/abdominal-aortic-ane
urysm/abdominal-aortic-aneurysm-repair
●  Thompson, G. (2021). Open Repair Surgery for Abdominal Aortic Aneurysm |
Michigan Medicine. Retrieved 19 September 2021, from
https://www.uofmhealth.org/health-library/abn3540
●  Abdominal aortic aneurysm - Diagnosis and treatment - Mayo Clinic. (2021).
Retrieved 19 September 2021, from https://www.mayoclinic.org/diseases-
conditions/abdominal-aortic-aneurysm/diagnosis-treatment/drc-20350693