AORTIC DISORDERS

ABDOMINAL AORTIC ANEURYSM

• Localized dilation/outpouching ≥50% larger than normal

• Caused by weakening of the arterial wall

• Most occur below the renal arteries

• Risk of rupture ↑ with size (>6 cm = high risk)

AAA Symptomatic

• Abdominal/back/chest pain (tearing, stabbing)

• Pulsatile abdominal mass (classic!)

• “Blue toe syndrome” (embolization)

Abdominal Aortic Aneurysm Rupture

Sudden severe pain + hypotension + Tachycardia + ↓ urine output

EVAR (Endovascular Aneurysm Repair)

• Minimally invasive

• Insert graft via the femoral artery

Endoleak

asymptomatic complication following endovascular aneurysm repair (EVAR), where blood leaks back into the aneurysm sac, risking rupture

EVAR Post-Op

• Graft patency (check pulses!)

• Renal perfusion (urine output)

• No heavy lifting for 6 weeks

• Monitor pulses

THORACIC AORTIC ANEURYSM

• Deep chest pain radiating to the back

• Can compress surrounding structures

AORTIC DISSECTION

occurs when a tear in the inner layer (intima) of the aorta allows blood to surge into the middle layer (media), creating a false lumen that splits the aortic wall

• NOT an aneurysm

• Tear in intima → blood enters wall → false lumen

• Worsens with each heartbeat

Risk Factors AORTIC DISSECTION

• Chronic Hypertension (BIGGEST)

• Genetic disorders (Marfan, Ehlers-Danlos)

• Male gender

Type A AORTIC DISSECTION

• EMERGENCY

• Ascending aorta

• Requires surgery

Type B AORTIC DISSECTION

• Descending aorta

• Often medical management

Clinical Manifestation AORTIC DISSECTION

• Sudden “tearing/ripping” pain

• Chest or back pain

• Unequal BP between arms

• Pulse deficits

• Neuro deficits (if arch involved)

Complications For AORTIC DISSECTION

• Cardiac tamponade

• Aortic rupture → death

• Organ ischemia

Medical Management Type B AORTIC DISSECTION

↓ HR and BP (reduce shear stress)

Medications for AORTIC DISSECTION

Beta Blockers (FIRST LINE)

• ↓ HR → ↓ force on aorta

IV Antihypertensives (ex: Nitroprusside)

• Rapid BP control

Pain meds (opioids)

• ↓ sympathetic response

Nursing Interventions for AORTIC DISSECTION

• Lower BP ASAP

• Continuous BP + EKG monitoring

AORTIC DISSECTION Procedures

TEVAR (endovascular repair) Thoracic Endovascular Aortic Repair

• A small incision is made in the groin, allowing a surgeon to guide a stent-graft through the femoral artery into the thoracic aorta to seal the damaged area, often using imaging to guide placement.

AAA

• Often silent

• Pulsatile mass

• Rupture = shock

TAA

• Chest/back pain

• Compression symptoms

AORTIC DISSECTION

• Sudden tearing pain

• Unequal BP

• Type A = surgery NOW

AAA Rupture

Sudden hypotension + known AAA

Saccular Aneurysm

These are round, pouch-like, or "berry-shaped" outpouchings that develop at arterial junctions in the brain,

fusiform aneurysm

a type of blood vessel dilation where the entire circumference of the artery wall stretches and enlarges, forming a spindle-shaped ballooning

commonly occur in the aorta or cerebral arteries

AAA <5.5

Conservative management

Open Aneurysm Repair

Large abdominal incision / synthetic graft to the aorta above and below the aneurysm

higher risk option

aortic cross-clamping proximal and distal to an aneurysm

Aortic Dissection Onset

Acue - first 14 days

Subacute - 14-90 days

Chronic - > 90 dayes