MEDICAL SURGICAL

NURSING
SEMINAR ON

ANEURYSMS

SUBMITTED TO:

SUBMITTED BY:

DEEPALI MAM
TUTOR
SCON

MANOJ. P
MSC I YEAR
SCON

SUBMITTED ON:
13/8/2016

OBJECTIVES

GENERAL OBJECTIVE:
At the end of the seminar the IInd year MSc Nursing students will have gained adequate
knowledge on aneurysms.

SPECIFIC OBJECTIVE:
At the end of the seminar the students will be able to:
1.
2.
3.
4.
5.
6.
7.
8.

Define aneurysms
State the incidence of aneurysms
Classify the types of aneurysms
Enlist the etiology and risk factors
Explain the pathophysiology of aneurysms
Discuss the clinical manifestations and complications
List the diagnostic measures
Describe the medical and surgical management of aneurysm

ANEURYSMS

INTRODUCTION
An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall
of a blood vessel. Aneurysms can occur in any blood vessel, with examples including
aneurysms of the Circle of Willis in the brain, aortic aneurysms affecting the thoracic aorta,
and abdominal aortic aneurysms. Aneurysms can also occur within the heart itself.
As an aneurysm increases in size, the risk of rupture increases. A ruptured aneurysm can lead
to bleeding .Aneurysms are a result of a weakened blood vessel wall, and can be a result of a
hereditary condition or an acquired disease. Aneurysms can also be anidus for clot formation
(thrombosis) and embolization. The word is from Greek:, aneurysm, "dilation",
from ,aneurynein, "to dilate".

DEFINITION
ANEURYSMS are outpouchings or dilations of the arterial wall. It can also be
defined as a distension of an artery brought about by a weakening/destruction of arterial wall.

INCIDENCE
a) The aorta is the most common site of aneurysms
b) Aneurysms of peripheral arteries can also occur but are far less common
c) Aneurysms occur in men more often than in women
d) The incidence increases with age.

CLASSIFICATION
Aneurysms may be classified by type, morphology, or location.
1. TYPE
True aneurysm

 False aneurysm
A true aneurysm is one that involves all three layers of the wall of an artery, with
atleast one vessel layer still intact. True aneurysms include atherosclerotic, syphilitic and
congenital aneurysms, as well as ventricular aneurysms that follow transmural myocardial
infarctions (aneurysms that involve all layers of the attenuated wall of the heart are also
considered true aneurysms).
A false aneurysm, or pseudoaneurysm, is a collection of blood leaking completely
out of an artery or vein, but confined next to the vessel by the surrounding tissue. This bloodfilled cavity will eventually form either thrombose (clot) enough to seal the leak, or rupture
out of the surrounding tissue.
Pseudoaneurysms can be caused by trauma that punctures the artery, such as knife and
bullet wounds, as a result of percutaneous surgical procedures such as coronary
angiography or arterial grafting, or use of an artery for injection

2. MORPHOLOGY
Aneurysms can also be classified by their macroscopic shape and size, and are described
as either saccular, fusiform and dissecting. The shape of an aneurysm is not specific for a
specific disease.
Saccular aneurysms are spherical in shape and involve only a portion of the vessel
wall; they vary in size from 5 to 20 cm (8 in) in diameter, and are often filled, either
partially or fully, by a thrombus.
Fusiform aneurysms ("spindle-shaped" aneurysms) are variable in both their
diameter and length; their diameters can extend up to 20 cm (8 in). They often involve
large portions of the ascending and transverse aortic arch, the abdominal aorta, or less
frequently the iliac arteries.

3. LOCATION
Aneurysms can also be classified by their location:

Arterial and venous, with arterial being more common.

The heart, including coronary artery aneurysms, ventricular aneurysms, aneurysm of

sinus of Valsalva, and aneurysms following cardiac surgery.

The aorta, namely aortic aneurysms including thoracic aortic

aneurysms and abdominal aortic aneurysms.

The brain, including cerebral aneurysms, berry aneurysms, and CharcotBouchard

aneurysms.

The legs, including the popliteal arteries.

The kidney, including renal artery aneurysm and intra-parenchymal aneurysms.

Capillaries, specifically capillary aneurysms.

Cerebral aneurysms, also known as intracranial or brain aneurysms, occur most commonly in
the anterior cerebral artery, which is part of the circle of Willis. This can cause severe strokes
leading to death. The next most common sites of cerebral aneurysm occurrence are in the internal
carotid artery.

ETIOLOGY
Aneurysms may form as a result of:
1. Artherosclerosis
2. Heredity
3. Infection
4. Trauma
5. Immunologic conditions

RISK FACTORS

Contributing factors include:

1. Increasing age
2. Hypertension
3. Obesity
4. Diabetes
5. Tobacco use
6. Alcoholism
7. High cholestrol
8. Syphilis
9. Local infection, pyogenic or fungal(mycotic aneurysm)
10. Congenital weakness of vessels
11. Copper Deficiency leads to vessel wall thinning

PATHOPHYSIOLOGY

Etiological factors or artherosclerosis

Arteries lined with plaque/ thrombi

Due to high pressure in the arterial system, aneurysms enlarge

Increased arterial wall tension

Compresses the surrounding structures

If left untreated, may rupture

Causing hemorrhage

CLINICAL MANIFESTATIONS
Aneurysm presentation may range from life-threatening complications of hypovolemic shock to being found incidentally on X-ray. Symptoms will differ by the site of the
aneurysm and can include:
1. Cerebral aneurysm
Symptoms can occur when the aneurysm pushes on a structure in the brain.
Symptoms will depend on whether an aneurysm has ruptured or not. There may be no
symptoms present at all until the aneurysm ruptures. For an aneurysm that has not ruptured
the following symptoms can occur:

Fatigue

Loss of perception

Loss of balance

Speech problems

Double vision

For a ruptured aneurysm, symptoms of a subarachnoid hemorrhage may present:

Severe headaches
Loss of vision
Double vision
Neck pain and/or stiffness
Pain above and/or behind the eyes

2. Thoracic Aorta Aneurysm

Often asymptomatic

When symptoms present, the most common manifestation is deep diffuse chest
pain that may extend to inter-scapular area.

Aneurysms located in the ascending aorta and the aortic arch can produce angina
from disruption of blood flow to coronary arteries and hoarseness as a result of
pressure on the recurrent laryngeal nerve.

Pressure of esophagus can cause dysphagia.

If aneurysm passes on superior vena cava, decreased venous return can result in
distended neck veins and edema of head and arms.

3. Abdominal aneurysm

Usually asymptomatic

Abdominal pain most common, either persistent or intermittent

Feeling of an abdominal pulsating mass, palpated as a thrill, auscultated as a bruit
Epigastric discomfort
Altered bowel elimination from bowel compression
Lower back pain or lower limb ischemia
Blue toe syndrome patchy mottling of the feet and toes in the presence of
palpable pedal pulses

4. Renal (kidney) aneurysm

Flank pain and tenderness

Hypertension

Haematuria

Signs of hypovolemic shock

COMPLICATIONS
The most serious complication is rupture of the aneurysm which can lead to:

Fatal hemorrhage
Stroke
Paraplegia due to interruption of anterior spinal artery
Graft occlusion
Graft infections
Abdominal ischemia
Acute renal failure

DIAGNOSIS
a. Abdominal or chest X-ray: shows calcification that outlines aneurysm
b. ECG: to rule out evidence of MI
c. USG: monitors aneurysm size
d. CT Scan: most accurate test. Helps identify 3 dimensional view.
e. MRI: assesses location and severity
f. Angiography: helps identify involvement of other vessels.

MANAGEMENT
The goal of management is to prevent the artery from rupturing. Therefore early detection
and prompt treatment are imperative.
Medical management:
Once an aneurysm is suspected, studies are performed to detect exact size and
location
Careful review of all body systems to identify ant co-existing disorder which may
influence patients surgical risk
For small aneurysms (< 4cm), conservative treatment is initiated i.e.
i.

Risk factor modification

ii.

Decreasing blood pressure

iii.

Monitoring aneurysm size every 6 months

Surgical management:
1. Intracranial aneurysms
There are currently two treatment options for brain aneurysms:
surgical clipping
endovascular coiling

Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It
consists of a craniotomy to expose the aneurysm and closing the base or neck of the
aneurysm with a clip.

Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It consists of

passing a catheter into the femoral artery in the groin, through the aorta, into the brain
arteries, and finally into the aneurysm itself. Platinum coils initiate a clotting reaction within
the aneurysm that, if successful fill the aneurysm dome and prevent its rupture.

2. Aortic and peripheral aneurysms

For aneurysms in the aorta, arms, legs, or head, the weakened section of the vessel may be
replaced by a bypass graft that is sutured at the vascular stumps. Instead of sewing, the graft
tube ends, made rigid and expandable by nitinol wireframe, can be easily inserted in its
reduced diameter into the vascular stumps and then expanded up to the most appropriate
diameter and permanently fixed there by external ligature.

Nursing Diagnosis
1. Ineffective tissue perfusion (vital organs) related to aneurysm or aneurysm rupture or
dissection
2. Risk for infection related to surgery
3. Acute pain related to pressure of aneurysm on nerves or postoperatively
4. Potential complications: hypovolemic shock related to ruptured aneurysm
5. Deficient knowledge related to aneurysms
6. Ineffective therapeutic regimen management

CONCLUSION
Aneurysms are out pouching or dilations of the arterial wall which, if not managed
adequately can rupture and cause life threatening situations. Most aneurysms are
asymptomatic and are diagnosed due to secondary conditions, unless it has ruptured causing
complications. Unruptured aneurysms which are small can be treated conventionally or
surgical management may be required.

RESEARCH EVIDENCE
Nationwide Study on the Risk of Abdominal Aortic Aneurysms in Patients
With Psoriasis
Usman Khalid, Alexander Egeberg, Ole Ahlehoff, Laerke Smedegaard, Gunnar Hilmar
Gislason, Peter Riis Hansen
Author Affiliations
1. From the Department of Cardiology (U.K., O.A., L.S., G.H.G., P.R.H.), Department
of Dermatology (A.E.), Copenhagen University Hospital Herlev and Gentofte,
Hellerup, Denmark; Department of Cardiology, The Heart Centre, Copenhagen
University Hospital Rigshospitalet, Denmark (O.A.); National Institute of Public
Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); Faculty
of Health Sciences, University of Copenhagen, Copenhagen, Denmark (G.H.G.,
P.R.H.); and Department of Cardiovascular Epidemiology and Research, The Danish
Heart Foundation, Copenhagen, Denmark (G.H.G.).
1.
Correspondence to Usman Khalid, MD, Department of Cardiology, Herlev and
Gentofte Hospital, Post 635 Kildegrdsvej 28, 2900 Hellerup, Denmark. Emailusman.khalid@regionh.dk

Abstract
ObjectiveAbdominal aortic aneurysm (AAA) is a complex multifactorial disease associated
with a high morbidity and mortality. Increased inflammation including T-helper 17 cell
mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a Thelper 17-driven chronic inflammatory disease and in view of potentially overlapping
inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a
nationwide cohort.

Approach and ResultsThe study comprised all Danish residents aged 18 years followed
up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death.
Information on comorbidity, concomitant medication, and socioeconomic status was
identified by individual-level linkage of administrative registers. Incidence rates for AAA
were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications,
socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5
495 203 subjects were eligible for analysis. During the study period, we identified 59423
patients with mild psoriasis and 11566 patients with severe psoriasis. The overall incidence
rates of AAA were 3.72, 7.30, and 9.87 per 10000 person-years for the reference population
(23696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The
corresponding adjusted incidence rate ratios for AAA were increased in patients with
psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.031.39) and 1.67
(confidence interval, 1.212.32) for subjects with mild and severe disease, respectively.

ConclusionsIn a nationwide cohort, psoriasis was associated with a disease severitydependent increased risk of AAA. The mechanisms and consequences of this novel finding
require further investigation.

2016 American Heart Association, Inc.

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