ABDOMINAL AORTIC ANEURYSM
At what point do you do sx for an abdominal aortic aneurysm
>6cm (some say >5).
At what point do you do sx for a thoracic aneurysm
>7cm or symptomatic
What is the most common site for an aneurysm
Abdominal aortic, then femoral and popliteal arteries
What are causes of aneurysms
Atherosclerosis, trauma, syphilis (makes lesions that form in the blood vessels), congenital abnormalities of the vessel, infection and some connective tissue disorders (marfans syndrome), lupus, RA, smoking, HTN, genetic predisposition linked
Where do you monitor the pt for bleeding
Back of the neck or on the trachea
What are preop things to do for non emergent surgeries
Bowl prep, Bank autologous blood, monitor all peripheral pulses
What is the standard tool for assess size and location of an aortic aneurysm
CT scan
What is the #1 most serious complication with a carotid endarterectomy
Compromised cerebral blood flow
What are goals of an aortic dissection treatment
Decrease BP-bring it down quick if they're bleeding, elimination of pain, decrease in velocity of LV ejection,
What are other s/s of a dissecting aorta
Diaphoresis, N/V, faintness, apprehension, BP elevated, decrease or absence of peripheral pulses, decreased LOC, CVA, aortic regurgitation heard as murmur along right sterna border
What are other risks/complications of a carotid endarterectomy
Embolization of plaque and microthrombi, hyper or hypotension-because baro receptors are right in the carotid, bleeding and/or hemorrhage, nerve function damage, hyperperfusion syndrome
What is the most common type of aneurysm
Fusiform
What are the three primary types of aneurysms
Fusiform, saccular, dissecting
What is a dissecting aneurysm
Get a tear in the intima and the blood accumulates between the intima and media. Strongly associated with arterial hypertension and hemodynamic instability. Most common in thoracic aorta
Where do abdominal aortic aneurysms occur
Infra renal (below the kidneys) and supra renal (above the kidneys)
What are you looking for if a pt has compromised cerebral blood flow
LOC, Neuro checks done every hour-asking questions, cranial nerve testing
What are the advantages of doing an endovascular repair for an AAA than an excision
Less blood loss, hospitalization is 1-3 days vs 10 days
What are non surgical measures for an abdominal aneurysm
Maintain BP WNL monitor growth of the aneurysm
Who are abdominal aortic aneurysms more common in
Men 4:1 between 50-70
What is the #1 drug for pts dissecting
Nitroprusside-also used is beta blockers propranolol or esmolol (negative inotrope to slow HR and slow down LV contractility)
What are s/s of an aneurysm
Often asymptomatic, may be felt as a palpable mass, systolic bruit may be heard. May c/o abdominal or back pain
What is a saccular aneurysm
One side like a sack-higher incidence of rupture
What is the most frequent complication of an endovascular repair
Perigraft leaking
What will s/s be if an abdominal aneurysm leaks or ruptures
Severe pain, s/s of shock, decreased block cell count, increased WBC
What is a big side of effect of a AAA resection
Spinal cord ischemia-compartment syndrome
What area of an aneurysm is at higher risk
Supra renal because you are going to clamp the kidneys
What is an endovascular repair for AAA
Sutureless vascular graft that is inserted through the femoral artery
What are s/s of thoracic aneurysms
Symptoms depends on size-many pts are asymptomatic, may experience pain in anterior chest wall, back, flank or abdominal pain-may develop shock if leaks or ruptures. Dyspnea, cough or wheezing may develop if aneurysm puts pressure on trachea or bronchus
What patients is a carotid endarterectomy common in
TIAs or with stroke
What is the most common presenting symptom of an aortic dissection
Tearing, ripping, stabbing pain, moves from point of origin, pain may be felt in anterior chest, back, neck, throat, jaw or teeth
Who is more at risk of an aortic dissection
Those with connective tissue disorders (marfans syndrome), HTN, older adult 50-60, women in 3rd trimester of pregnancy
How long is a paralytic ileus expected after a AAA resection
Up to 3 days
What cranial nerves will you monitor after a carotid endarterectomy
VII-facial-drooping of corner of lip, X-vagus-intact gag and swallowing, XII-hypoglossal-may cause difficulty with mastication and speech, tongue deviation to side of surgery
When will a carotid endarterectomy be done
When the blockage is >70%
What is a fusiform aneurysm
Whole vessel is effected and just one big bulky pouch