10/28/2019 1 Aortic Aneurysm: A ticking time bomb Mary McGreal DNP, RN, ANPC Objectives • Discuss the incidence of aortic aneurysm? • Discuss the pathogenesis of aortic aneurysm? • Discuss clinical manifestation of aortic aneurysm? • Discuss the diagnostic criteria for aortic aneurysm and outline the treatment modalities? Disclosure • No disclosures 1 2 3
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10/28/2019
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Aortic Aneurysm: A ticking time bomb
Mary McGreal DNP, RN, ANPC
Objectives
• Discuss the incidence of aortic aneurysm?
• Discuss the pathogenesis of aortic aneurysm?
• Discuss clinical manifestation of aortic aneurysm?
• Discuss the diagnostic criteria for aortic aneurysm and outline the treatment modalities?
Disclosure
• No disclosures
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Background
• Aortic aneurysms strike 1.5 to 2 million Americans and cause 15,000 deaths each year
• Aortic Aneurysm is known as silent killer
• Incidental finding during work-up for another condition• The burden of aneurysmal disease is on the rise due to:
• Demographic transition that is occurring
• Improved imaging techniques • Creating awareness about aortic aneurysms is important
Aortic Aneurysm• The term ANEYRYSM is derived from the Greek word
ANEURYSMA meaning “a widening”
• A permanent localized dilation of the aorta artery having at least 50% increase in diameter compared with the expected diameter.
• Normal artery diameter is dependent on age, gender, and body size
• Aortic aneurysms arise as a result of a failure of the major structural proteins of the aorta (elastin and collagen)
• The inciting factors are not known, but a genetic predisposition
clearly exists
Anatomy
• The aorta is the largest artery in the body• It is divided in 2 main sections
��Thoracic aorta
Aortic rootAscending aortaArch
Descending� Abdominal aorta
• The diameter of the aorta decreases from its thoracic portion to its abdominal portions
Caleron & Illig (2016)
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Aorta
Salameh et al.2018
Anatomy
• The aortic wall is composed of the three layers:
• The inner tunica intima lined by the endothelium
• The thick tunica media ---collagen and smooth muscle
• The outer adventitia---- mainly collagen
Caleron & Illig (2016)
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Classification• The aneurysms are classified as
either:• Saccular- ballooning of a focal
area of the aorta• Fusiform--circumferential dilation
of the aorta• Aneurysms are either true or
false. The wall of a true aneurysm involves all three layers, and the aneurysm is contained inside the endothelium. The wall of a false or pseudo aneurysm only involves the outer layer and is contained by the adventitia
• An aortic dissection occurs following a tear in the intimal layer of the aortic wall causing blood to flow between the layers of the aortic wall
• There 2 classification systems
• De Bakey
• StanfordRagavendra et al. (2014)
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De Bakey Classification• Categorizes dissections into types I, II, and III.
• Type I: Originates in the ascending aorta and spreads distally to include the aortic arch and typically the descending aorta
• Type II: Originates in and is confined to the ascending aorta
• Type III: Originates in the descending aorta and spreads distally
Ragavendra, et al. (2014)
Stanford Classification System
• Divides dissections into 2 categories
• Those that involve the ascending aorta and those that do not
• Type A: All dissections involving the ascending aorta
• Type B: All dissections that do not involve the ascending aorta
Ragavendra, et al. (2014)
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References
• Caleron, A &, Illig, K.A (2016). Overview of aortic aneurysm management in the endovascular era. Seminar in Vascular Surgery 29: 3-17.
• Ragavendra R., et al. (2014).The Role of Imaging in aortic dissection and related syndromes. Retrieved July, 2019 from http://imaging.onlinejacc.org/
• Rahimi, S. (2017). Abdominal aortic aneurysm. Medscape. Retrieved July, 2019, from http://emedicine.medscape/article/1979501-overview
• Saliba E., Sia Y. ( 2015). The ascending aortic aneurysm: When to intervene?
Int J Cardiol Heart Vasc ; 6: 91–100.
• Salameh, M., Black, J., Ratchford, E. (2018). Thoracic aortic aneurysm. Vascular Medicine: 23(6) 573–578.
• Swerdlow, N., Wu, W., Schermerhorn, M. (2019). Open and endovascular management of aortic aneurysms. Circulation Research: 124:647–661
• US Preventative Task force (2017) Abdominal aneurysm screening guideline. Retrieved July, 2019
from www.uspreventiveservicestaskforce.org/abdominal-aortic-aneurysm-screening