Aortic Aneurysm

WHAT WENT WRONG?

A weakening in the wall of a portion of the aorta results in a balloon-like bulge as

blood flows through the aorta. The blood flow within this bulging area of the aorta

becomes very turbulent. Over time this turbulence can cause the dilated area to

increase in size, creating an aneurysm. The aneurysm can rupture causing a disruption

in blood flow to everything below the affected area, and may even result

in death.

This is commonly due to atherosclerosis where fatty substances, cholesterol,

calcium and the clotting material fibrin, referred to as plaque, build up in the inner

lining of an artery resulting in thickening and hardening of the arteries. It may also

be caused by degeneration of the smooth muscle layer (middle) of the aorta,

trauma, congenital defect, or infection. The aneurysm may be found incidentally

on radiographic studies done for other reasons, or the patient may have developed

symptoms indicating that something was wrong, such as severe back or abdominal

pain, or a pulsating mass. Severe hypotension and syncope (fainting caused by

insufficient blood supply to the brain) may indicate rupture.

PROGNOSIS

Outcome will vary depending on size and location of aneurysm. Some patients

have aneurysms for months before a diagnosis is made, because they are asymptomatic.

Treatment decisions will depend on the size and location of the aneurysm.

Some patients with an aneurysm will have watchful waiting with periodic imaging

to monitor the size of the aneurysm while other patients may need emergent

surgery.

HALLMARK SIGNS AND SYMPTOMS

• Asymptomatic

• Abdominal pain

• Back pain that may radiate to posterior legs

• Abdominal pulsation• Diminished femoral pulses

• Anxiety

• Restlessness

• Decreased pulse pressure

• Increased thready pulse

INTERPRETING TEST RESULTS      

• An aneurysm will be displayed in a chest x-ray, abdominal ultrasound, CT

scan, or MRI.

• Swishing sound over the abdominal aorta or iliac or femoral arteries because

the natural flow of blood is disturbed (bruit).

TREATMENT

• Surgery to resect the aortic aneurysm by removing the section containing the

aneurysm and replacing it with a graft.

• Administer antihypertensives, reducing the force of the pressure within the

aorta to decrease the likelihood of rupture.

• Administer analgestics to treat patients who may be having pain from pressure

on nearby structures (nerves, etc.) or tearing of the vessel.

• Administer oxycodone, morphine sulfate as needed to decrease oxygen

demand.

DIAGNOSES

• Ineffective peripheral tissue perfusion

• Risk for deficient fluid volume

• Acute pain

• Anxiety

INTERVENTION

• Monitor vital signs—look for changes in blood pressure or elevated pulse

and respiratory rates. During aortic dissection the blood pressure (BP) may

initially increase due to severity of pain. It may then become difficult toimpossible to obtain both the BP and pulse in one or both arms because of

blood flow disruption to the arm(s). The patient may go into shock quickly

if the aneurysm ruptures.

• Monitor cardiovascular system by checking heart sounds, peripheral pulses

(upper and lower extremities), and checking for abdominal bruits, swishing

sounds heard over the blood vessel when flow is disturbed.

• Measure intake and output.

• Hypovolemia is suspected if there is a low urine output and high specific

gravity of urine.

• Palpate abdomen for distention or pulsatile mass.

• Abdominal distention, which is an enlarged abdomen, may signify imminent

rupture of the aneurysm.

• Check for signs of severe decrease in blood or fluid (hypovolemic shock).

The BP decreases as less blood circulates. Pulse rate increases as the heart

tries to pump the blood faster to meet the oxygen demands of the body.

Respiratory rate increases to meet oxygen needs while peripheral pulse sites

are harder to find as BP lowers. The further away the pulse is from the heart,

the more difficult it will be to find; it will be harder to locate the dorsalis

pedis and posterior tibialis pulses earlier than the radial pulses.

• Pale, clammy skin will be present as circulation decreases.

• Severe back pain due to rupture or dissection.

• Anxiety due to uncertainty of what is happening.

• Restlessness due to anxiety, discomfort, and decreased oxygenation.

• Decreased pulse pressure due to less circulating volume, increased heart rate,

and less filling time between heartbeats.

• Increased thready pulse.

• Limit patient’s activity to a prescribed exercise and rest regimen.

• Be alert for decreased peripheral circulation.

• Numbness.

• Tingling.

• Decrease in temperature of extremities.

• Change in skin color in extremities.

• Absence of peripheral pulses.

• Reduce patient anxiety.

• Maintain a quiet place.

• Have the patient express his or her feelings.

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