Treatment of abdominal aortic aneurysms (AAAs) consists of surgical repair. When indicated, an unruptured aneurysm can undergo elective surgical repair; a ruptured AAA calls for emergency repair. [ 18, 19] Possible approaches include the traditional open laparotomy, newer minimally invasive methodologies, and the placement of endovascular stents.
Full Answer
Can a ruptured aortic aneurysm be treated?
Treatment of a ruptured aortic aneurysm is an emergency that cannot be planned in advance. A ruptured aortic aneurysm is a fatal event if not treated immediately. Even with the best treatment, the mortality rate is exceedingly high. There is only one lifestyle factor that has been proven to have an impact on aortic aneurysms, and that is smoking.
What is the best way to diagnose a ruptured aorta?
On a few occasions we have done MRI, and it has proven to be as good as the spinal CT in diagnosing ruptured aorta. Regarding the mortality, 10% of the patients die between the door of the operating room and the patient being placed on bypass. When the rupture finally occurs, there isn’t much that you can do.
What are the treatment options for acute aortic dissection?
Approach Considerations. Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft.
When is urgent treatment indicated for an aortic aneurysm?
Even with clear findings of hematoma around the aneurysm, contained or impending rupture of an aortic aneurysm is an indication for urgent treatment because of the risk of subsequent rupture [ 1 ].
How do you treat aortic rupture?
TreatmentSurgery. Surgeons remove as much of the dissected aorta as possible and stop blood from leaking into the aortic wall. ... Medications. Medications are given to reduce heart rate and lower blood pressure, which can prevent the aortic dissection from worsening.
What is the priority nursing management for aortic dissection?
Immediate patient transfer to the intensive care unit (ICU) is a high priority. Nursing interventions should begin as soon as aortic dissection is suspected, and typically include the following: Institute intubation or mechanical ventilation, as ordered, if the patient is hemodynamically unstable.
What is the drug that you are going to administer if you are suspecting aortic dissection?
To prevent exacerbations of tachycardia and hypertension, treat patients with intravenous morphine sulfate. This reduces the force of cardiac contraction and the rate of rise of the aortic pressure. It then retards the propagation of the dissection and delays rupture.
What happens when aortic valve ruptures?
Sudden severe chest or upper back pain, often described as a tearing or ripping sensation, that spreads to the neck or down the back. Sudden severe stomach pain. Loss of consciousness. Shortness of breath.
Which of the following is a common treatment for abdominal aortic aneurysm?
Endovascular repair. This procedure is used most often to repair an abdominal aortic aneurysm. A surgeon inserts a thin, flexible tube (catheter) through an artery in the leg and gently guides it to the aorta.
Why is labetalol used in aortic dissection?
EDITOR,—Adrian P Banning and colleagues state that labetalol is the drug of choice to control arterial pressure in patients with suspected dissection of the thoracic aorta. 1 Labetalol is an appropriate hypotensive agent in certain circumstances but is disadvantaged by its relatively long half life (3-5 hours).
Which beta blockers are used in aortic dissection?
Intravenous propranolol, metoprolol, labetalol, or esmolol are suggested as excellent choices for initial treatment. In patients who are unable to tolerate beta-blockade, non-dihydropyridine calcium channel antagonists (verapamil, diltiazem) were suggested to offer acceptable, although less-established, alternatives.
Is Nitroglycerin contraindicated in aortic dissection?
Vasodilator therapy (nitroprusside, nitroglycerin) should not be started before or without beta-blockers, as it can result in a reflex tachycardia increasing shear stress on the aorta. Thoracic surgery should be consulted immediately for recommendations regarding surgical repair.
Is anticoagulation contraindicated in aortic aneurysm?
Aortic dissection (AD) has been viewed as a contraindication to the use of anticoagulants, due to the high risk of bleeding in the event of aortic rupture or an urgent/emergent need for surgery.
What is aortic rupture?
Traumatic aortic transection, also known as aortic rupture, is the near-complete tear through all the layers of the aorta due to trauma such as that sustained in a motor vehicle collision or a fall. This condition is most often lethal and requires immediate medical attention.
What causes aortic rupture?
It's believed that most aortic dissections are caused by an underlying vulnerability that may be inherited. In others, the stress to the aortic wall from constant high blood pressure can weaken the aorta wall in susceptible people, resulting in a tear and dissection.
Can you survive an aortic rupture?
Yes, you can live with an aortic aneurysm, and there are many ways to prevent dissection (splitting of the blood vessel wall that causes blood to leak) or worse, a rupture (a burst aneurysm).
What is the treatment for a thoracic aortic aneurysm?
Thoracic Aortic Aneury... In addition to surgery, careful monitoring and blood pressure medication are also used to treat aneurysms that are not at risk of rupturing. Shutterstock (2); iStock. Aneurysms are a serious health condition, but not all cases require surgery or aggressive treatment.
How to stop blood flow in aneurysm?
Using a microscope to locate the blood vessel that feeds the aneurysm, the surgeon places a small titanium clip across the neck of the aneurysm to stop the blood flow.
What is the best way to repair a brain aneurysm?
There are two options for a ruptured brain aneurysm: endovascular embolization (or EVAR repair) and microvascular clipping. The type of surgery your doctor chooses is largely dependent on the size and location of the aneurysm. It can also depend on the following factors: (3) The patient’s age. The shape of the aneurysm.
How long does it take to recover from an aneurysm?
If the aneurysm is uncomplicated, the recovery time for endovascular stenting is much shorter than it is for surgery: one to three days versus 7 to 10 days, Teitelbaum says.
What to do if an aneurysm is growing?
Surgery. If an aneurysm is growing or at risk of rupture or dissection, your doctor will likely perform surgery. Brain aneurysms that have burst will require emergency surgery for the aneurysm itself and to evacuate blood from the skull, or to drain excess fluid from the brain.
How often should an aneurysm be checked?
The size of the aneurysm and how fast it grows are two factors that will determine how frequently you may need testing. The larger and faster the aneurysm grows, the more often your doctor should check it. (1)
How long does it take to recover from microvascular clipping?
Because it’s an invasive surgery, microvascular clipping recovery time may span between three and six weeks. ( 6) An occlusion is another, similar procedure is which the entire artery that leads to the aneurysm is clamped off and is usually performed when there is damage to the artery.
What is the most reliable diagnostic tool for aortic dissection?
Computed tomography (CT) is the most reliable diagnostic tool in patients with acute aortic dissection or ruptured aortic aneurysm. Today, CT is available in most emergency rooms and can be performed rapidly [ 6, 22 ]. CT clearly demonstrates the site, location, size, and extent of the aortic aneurysm and clearly shows the relationship between the aneurysm and neighboring organs or vessel branches. Reconstructed 3-D imaging helps guide the surgical approach to the aneurysm.
Which type of aorta has the first entry in the ascending aorta?
Type II has the first entry in the ascending aorta and does not propagate to the aortic arch. Type III has the first entry in the descending aorta and propagates distally above (type IIIa) or below (type IIIb) the diaphragm.
What is the leading cause of death in cardiovascular disease?
Acute aortic syndrome, including acute aortic dissection and ruptured aortic aneurysm, is the leading cause of death in cardiovascular disease. However, continuous advances in imaging and treatment technologies are improving short- and long-term outcomes.
How long does it take for aortic dissection to occur?
Acute aortic dissection is defined as dissection occurring within 2 weeks of onset of pain [ 2 ]. Subacute and chronic dissections occur between 2 and 6 weeks, and more than 6 weeks from the onset of pain, respectively [ 2 ].
What are the risk factors for aortic valve disease?
Other risk factors include age, male sex, smoking, pre-existing aortic diseases or aortic valve disease, family history of aortic diseases, history of cardiac surgery, direct blunt trauma, and the use of intravenous drugs (such as cocaine or amphetamines) [ 1, 2, 6 ].
What is the pain of aortic dissection?
Patients with type A aortic dissection commonly have anterior chest pain ; those with type B more frequently have back pain [ 7 ].
What is the best diagnostic tool for aortic syndrome?
Magnetic resonance imaging (MRI) is considered an accurate diagnostic tool for detecting acute aortic syndrome (sensitivity and specificity, 98%) [ 30 ]. MRI produces high-resolution aortic imaging with 3-D; however, it is rarely performed in emergency settings because of several limitations [ 6 ], including that it is not available in most emergency departments and it is inconvenient with a relatively long imaging acquisition time. MRI also cannot be performed in patients with claustrophobia, or in those with pacemakers, aneurysm clips, or other metal devices. Magnetic resonance angiography is used for patients who are allergic to the iodinated contrast agents used in CT or as a second diagnostic tool when CT is inadequate or the true diagnosis remains uncertain.
What is the best treatment for aortic dissection?
Medical management with antihypertensive therapy, including beta blockers, is the treatment of choice for all stable chronic aortic dissections. Pain management is an important but difficult aspect of medical therapy. Narcotics and opiates are the preferred agents.
How is aortic dissection treated?
Acute aortic dissection can be treated surgically or medically. In surgical treatment, the area of the aorta with the intimal tear is usually resected and replaced with a Dacron graft.
What is the purpose of aortic dissection surgery?
The major objectives of surgery for aortic dissection are to alleviate the symptoms, decrease the frequency of complications, and prevent aortic rupture and death. The affected layers of the aorta are sutured together, and the aorta is reinforced with a Dacron graft.
What is the mortality rate of aortic arch dissection?
The mortality associated with aortic arch dissections is approximately 10-15%.
What are the factors that increase the mortality and morbidity rates for surgical intervention on the aorta?
Numerous factors may increase mortality and morbidity rates for surgical intervention on the aorta, including a history of myocardial infarction, respiratory failure, renal failure, or stroke. Preoperative evaluation is, therefore, essential in patients with these histories.
What is type A dissection?
Patients with type A dissections are treated with immediate surgical correction. This involves transfer to the operating room, where median sternotomy is performed. Profound hypothermia is initiated after the patient is placed on cardiopulmonary bypass. Cardiopulmonary bypass is performed by femoral-femoral cannulation and through the superior vena cava for retrograde cerebral perfusion.
Which artery is transection of the proximal descending aorta?
The operation involves transection of the proximal descending aorta distal to the left subclavian artery. The proximal and distal intima and adventitia of the transected aorta are reinforced in the same manner as that for the ascending aorta, with a 4-0 polypropylene suture.
What is the nursing care plan for an aortic aneurysm?
Nursing care plan for clients with an aortic aneurysm is to modify risk factors, controlling the BP to prevent strain on the aneurysm, recognizing symptoms early, and preventing the occurrence of a rupture.
What is an aortic aneurysm?
Aortic aneurysm (Abdominal Aneurysm; Dissecting Aneurysm; Thoracic Aneurysm;) is a localized, circumscribed, blood -filled abnormal dilation of an artery caused by disease or weakening of the vessel wall.
What are the two types of aneurysms?
The two types of true aneurysms are: (1) saccular, which is characterized by a bulbous out-pouching of one side of the artery resulting in localized stretching in localized stretching of the artery wall, and (2) fusiform , which is characterized by a uniformly shaped dilation of the entire circumference of the artery.
What is dissecting AAA?
A dissecting AAA is the most catastrophe involving the aorta, and it has a high mortality rate if not detected early and treated with surgery. More than 90% of clients present with sudden onset of severe pain which is usually described, as sharp, tearing, or stabbing in nature.
Where are aneurysms most commonly seen?
Aneurysms are most commonly seen in the abdominal aorta. Abdominal aortic aneurysm (AAAs) account for about 75% and thoracic aneurysms for about 25% of all cases. They occur more often in men than in women.
What are the risk factors for dissection?
Risk factors for dissection include congenital, inflammatory, hypertension, pregnancy, trauma, and Marfan syndrome.
Can an aneurysm be repaired?
Risk factors include smoking and familial history of aneurysms. When an aneurysm becomes large enough for risk for rupture, it can be repaired by open surgical repair or a less-invasive endograft-covered stent repair.