Disorders of the
Aorta
Chapter 41
Adapted by H. Brown DNP, RN
2023
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Aorta
 Largest artery
 Responsible for supplying
oxygenated blood to essentially all
vital organs
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Disorders of the Aorta
 Most common vascular problems of
aorta


Aneurysms
Aortic dissection
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Aortic Aneurysms
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Aortic Aneurysms
Definition
 Outpouching or dilation of the
arterial wall
 Common problems involving aorta
 Occur in men more often than in
women
 Incidence ↑ with age
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Abdominal Aortic Aneurysm
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Aortic Aneurysms
Etiology and Pathophysiology
 May have aneurysm in more than
one location
 Aorta larger than 3 cm in diameter
is considered aneurysmal
 Growth rate unpredictable

The larger the aneurysm, the greater
the risk of rupture
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Aortic Aneurysms
Risk Factors
 Age
 Male gender
 High blood pressure (BP)
 Coronary artery disease
 Family history
 High cholesterol
 Lower extremity PAD
 Carotid artery disease
 Previous stroke
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Aortic Aneurysms
Risk Factors
 Tobacco use
 Being overweight or obese
 White and Native Americans have
higher risk
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Aortic Aneurysms
Genetic Link
 Bicuspid aortic valve
 Coarctation of the aorta
 Turner’s syndrome
 Autosomal dominant polycystic
kidney disease
 Ehlers-Danlos syndrome
 Loeys-Dietz syndrome
 Marfan’s syndrome
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True vs. False Aneurysm
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Aortic Aneurysms
Classification
 True aneurysm
 Wall of artery forms the aneurysm
 At least one vessel layer still intact

False aneurysm-Disruption of all
layers of arterial wall

Results in bleeding contained by
surrounding structures
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Aortic Aneurysm
Clinical Manifestations
 Thoracic aorta aneurysms
 Often asymptomatic
 Most common manifestation
Deep diffuse chest pain
 Pain may extend to the intrascapular
area

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Aortic Aneurysm
Clinical Manifestations
 Ascending aorta/aortic arch
 Angina
 Hoarseness
 If presses on superior vena cava

Decreased venous return


Distended neck veins
Edema of face and arms
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Aortic Aneurysm
Clinical Manifestations
 Abdominal aortic aneurysms (AAA)
 Often asymptomatic
 Frequently detected
On physical exam
 When patient examined for unrelated
problem (i.e., CT scan, abdominal x-ray)

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Aortic Aneurysm
Clinical Manifestations
 AAA
 May mimic pain associated with
abdominal or back disorders
 May spontaneously embolize plaque

Causing “___blue toe ______syndrome”

Patchy mottling of feet/toes with presence of
palpable pedal pulses
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Aortic Aneurysm
Complications
 Rupture—serious complication
 Rupture into retroperitoneal space
Bleeding may be tamponaded by
surrounding structures, thus preventing
exsanguination and death.
 Severe back pain
 May/may not have back/flank ecchymosis

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Aortic Aneurysm
Diagnostic Studies
 X-rays
 Chest – demonstrate mediastinal
silhouette and any abnormal
widening of thoracic aorta
 Abdomen – may show calcification
within wall of AAA
 ECG – to rule out MI
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Aortic Aneurysm
Diagnostic Studies
 Echocardiography
 Assists in diagnosis of aortic valve
insufficiency
 Ultrasonography
 Useful in screening for aneurysms
 Monitors aneurysm size
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Aortic Aneurysm
Diagnostic Studies
 CT scan
 Most accurate test to determine
Anterior-to-posterior length
 Cross-sectional diameter
 Presence of thrombus
 Best type of surgical repair

 MRI
 Diagnose and assess the location and
severity
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Aortic Aneurysm
Collaborative Care
 If carotid and/or coronary artery
obstruction present, may need to
correct before repair
 Small aneurysm (4- 5.5 cm)

Conservative therapy used
Risk factor modification
 ↓ blood pressure
 Ultrasound, MRI, CT scan monitoring
annually

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Aortic Aneurysm
Collaborative Care
 5.5 cm is threshold for repair
 Intervention at >5 cm in women with
AAA
 Surgical intervention may occur
earlier in




Patients with a genetic disorder
Rapidly expanding aneurysm
Symptomatic patients
High rupture risk
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Aortic Aneurysm
Collaborative Care
 Surgical therapy
 If ruptured, emergent surgical
intervention required


90% mortality with ruptured AAAs
Preop
Hydration
 Stabilize electrolytes, coagulation, and
hematocrit

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Surgical Repair of Aneurysm
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Aortic Aneurysm
Collaborative Care
 Autotransfusion reduces need for
blood transfusion during surgery
 AAA resection



Require cross-clamping of aorta
proximal and distal to aneurysm
Can be completed in 30 to 45 minutes
Clamps are removed and blood flow
to lower extremities is restored
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Aortic Aneurysm
Collaborative Care
 Endovascular graft procedure
 Benefits
↓ anesthesia and operative time
 Smaller operative blood loss
 ↓ morbidity and mortality
 More rapid resumption of physical activity
 Shortened hospital stay
 Quicker recovery
 Higher patient satisfaction
 Reduction in overall costs

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Nursing Management
Assessment
 Monitor for indications of rupture
 Diaphoresis
 Pallor
 Weakness
 Tachycardia
 Hypotension
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Nursing Management
Assessment
 Monitor for indications of rupture
 Abdominal, back, groin, or
periumbilical pain
 Changes in level of consciousness
 Pulsating abdominal mass
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Nursing Management
Nursing Implementation
 Acute intervention
 Postop

Maintain graft patency





Normal blood pressure
IV fluids and blood components
CVP or PA pressure monitoring
Urinary output monitoring
Avoid severe hypertension

Drug therapy may be indicated
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Aortic Dissection
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Aortic Dissection
 Often misnamed “dissecting
aneurysm”
 Not a type of aneurysm
 Result of a false lumen through
which blood flows
 Classified by location and duration
of onset
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Aortic Dissection
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Aortic Dissection
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Aortic Dissection
Clinical Manifestations
 Pain characterized as
 Sudden, severe pain in anterior part
of chest, or scapular pain radiating
down spine to abdomen or legs
 Described as “sharp” and “worst
ever”
 May mimic that of MI
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Aortic Dissection
Clinical Manifestations
 Cardiovascular, neurologic, and
respiratory signs may be present
 If aortic arch involved

Neurologic deficiencies may be
present
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Aortic Dissection
Complications
 Cardiac tamponade
 Severe, life-threatening complication
 Occurs when blood escapes from
dissection into pericardial sac
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Aortic Dissection
Complications
 Cardiac tamponade
 Clinical manifestations include
Hypotension
 Narrowed pulse pressure
 Distended neck veins
 Muffled heart sounds
 Pulsus paradoxus

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Aortic Dissection
Complications
 Aorta may rupture
 Results in exsanguination and death
 Hemorrhage may occur in
mediastinal, pleural, or abdominal
cavities
 Occlusion of arterial supply to vital
organs
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Aortic Dissection
Diagnostic Studies
 ECG to rule out MI
 Chest x-ray
 3-D CT scan
 Transesophageal echocardiography
 MRI
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Aortic Dissection
Collaborative Care
 Initial goal
 ↓ BP and myocardial contractility to
diminish pulsatile forces within aorta
 HR less than 60 and SBP 100-110
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Aortic Dissection
Collaborative Care
 Drug therapy
 IV β-adrenergic blocker


Esmolol (Brevibloc)
Other antihypertensive agents
Calcium channel blockers
 Nitroprusside
 Angiotensin-converting enzyme
inhibitors


Morphine
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Aortic Dissection
Collaborative Care
 Conservative therapy
 If no symptoms


Can be treated conservatively for a
period of time
Pain relief and BP control
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Aortic Dissection
Collaborative Care
 Endovascular dissection repair
 Standard to treat acute descending
aortic dissections with complications
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Aortic Dissection
Collaborative Care
 Surgical therapy
 Involves resection of aortic segment
and replacement with synthetic graft
material
 Women experience poorer surgical
outcomes and higher mortality than
men
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Audience Response Question
Following an aortic aneurysm repair, the patient
suddenly develops severe pain in the right lower
extremity. The right pedal pulse is decreased, and the
right foot is cool and pale. Which complication should
the nurse suspect?
a.
b.
c.
d.
Hypothermia
A wound infection
Bleeding from the graft site
An embolization or graft occlusion
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