Mr. Husain Nadaf, Tutor.

1. ANEURYSM
GUIDED BY :
MR. AMOS TALSANDEKAR
ASSISTANT PROFESSOR
MEDICAL – SURGICAL NURSING
D.Y PATIL COLLEGE OF
NURSING

2. ANATOMY OVERVIEW
• Arteries are thick-walled structures that carry
blood from the heart to the tissues.
• The aorta, which has a diameter of
approximately25 mm (1 inch), gives rise to
numerous branches, which divide into smaller
arteries that are about 4 mm in diameter by the
time they reach the tissues.
• The walls of the arteries and arterioles are
composed of three layers the intima, an inner
endothelial cell layer; the media, a middle
layer of smooth elastic tissue; and the
adventitia, an outer layer of connective tissue.

3. • The intima, a very thin layer, provides a smooth
surface for contact with the flowing blood.
• The media makes up most of the vessel wall in
the aorta and other large arteries of the body.
• This layer is composed chiefly of elastic and
connective tissue fibers that give the vessels
considerable strength and allow them to constrict
and dilate to accommodate the blood ejected from
the heart (stroke volume) and maintain an even,
steady flow of blood.
• Then flows continues within capillaries, veins,
venules until it reaches to smallest unit of body.

4. DEFINITION
• An aneurysm is a permanent localized sac or
dilation formed at a weak point in the wall of
the artery.
• The most common forms of aneurysms are
saccular or fusiform.
• A sacular aneurysm projects from one side of
the vessel only.
• If an entire arterial segment becomes dilated, a
fusiform aneurysm develops.
• Commonly affects brain, aorta, legs and spleen

6. CLASSIFICATION
A true aneurysm is one that
involves all three layers of the
wall of an artery
(intima, media and
adventitia) as it
includes atherosclerotic, syphil
itic, and congenital aneurysms,
as well as ventricular
aneurysms.

7. A false aneurysm, or pseudo aneurysm, is a collection of
blood leaking completely out of an artery or vein, but
confined next to the vessel by the surrounding tissue. This
blood-filled cavity will eventually either thrombose (clot)
enough to seal the leak, or rupture out of the surrounding
tissue as it is caused by trauma that punctures the artery,
such as knife and bullet wounds, of percutaneous surgical
procedures such as coronary angiography or arterial
grafting

8. LOCATIONS
• Arterial and venous, with arterial being more
common.
• The heart including coronary artery
aneurysms, ventricular aneurysms.
• The aorta, namely aortic
aneurysms including thoracic aortic
aneurysms and abdominal aortic aneurysms.
• The brain, including cerebral aneurysms, berry
aneurysms.
• The legs, including the popliteal arteries.
• The kidney, including renal artery aneurysm and
intra-parenchyma aneurysms.
• Capillaries, specifically capillary aneurysms.

12. RISK FACTORS
• Diabetes & High cholesterol - When a diabetic
has very high blood and cholesterol levels, this
promotes atherosclerosis and therefore
aneurysms.
• Copper deficiency - Copper enzymes regulate
physiologic pathways such as energy
production, iron metabolism, connective tissue
maturation and neuro-transmission. A copper
deficiency can cause dysfunction in blood
cells, bone and connective tissue
abnormalities, neurologic disorders

13. • Obesity - When your BMI is greater than 30
which leads to increase in adiposity of tissues
• Hypertension
• Tobacco use & alcoholism
• Increasing age
• Tertiary syphilis infection - The third stage
of syphilis also manifests as aneurysms which
is due to loss of the vasa vasorum in the tunica
adventitia
• Congenital resulting from inborn abnormality
in artery wall

14. SIGNS & SYMPTOMS
• Symptoms of an aneurysm vary with each type
and location.
• It’s important to know that aneurysms that
occur in the body or brain generally don’t
present signs or symptoms until they rupture.
but Aneurysms that occur near the surface of
the body may show signs of swelling and pain.
A large mass may also develop.

15. Cerebral Aneurysms
• Fatigue
• Loss of perception
• Loss of balance
• Speech problems
• Double vision
• Severe headaches
Abdominal Aneurysms
• Abdominal aneurysms are usually
asymptomatic, but rarely can cause lower back
pain or lower limb ischemia

16. Renal Aneurysm
• Flank pain and tenderness
• Hypertension
• Haematuria
• Signs of hypovolemic shock

17. PATHOPHYSIOLOGY
• Multiple factors, including factors affecting a
blood vessel wall and the blood through the
vessel, contribute :
1) Artherosclerosis
2) Syphillis
3) Copper deficiency

18. • Atherosclerosis - A variety of different factors,
including atherosclerosis, may contribute to
weakening of a blood vessel wall. The repeated
trauma of blood flowing through the vessel may
contribute to degeneration of the vessel wall.
• Hypertensive injury may compound this
degeneration and accelerate the expansion of the
aneurysm.
• As the aneurysm expands, the wall tension
increases. The pressure of blood within the
expanding aneurysm may also injure the blood
vessels supplying the artery itself, further
weakening the vessel wall. Without treatment,
these aneurysms will ultimately progress and
rupture.

19. • A Syphilis called mycotic aneurysm that
results from an infectious process that involves
the arterial wall, A person with a mycotic
aneurysm has a bacterial infection in the wall
of an artery, resulting in the formation of an
aneurysm. The most common locations include
arteries in the abdomen, thigh, neck, and arm.

20. • Copper Deficiency - A minority of aneurysms
are caused by copper deficiency, which results
in a decreased activity of the lysyl
oxidase enzyme, affecting elastin, a key
component in vessel wall Copper deficiency
results in vessel wall thinning.

21. DIAGNOSTIC EVALUATION
1)Diagnosis of a ruptured cerebral aneurysm is
commonly made by finding signs of
subarachnoid hemorrhage on a computed
tomography (CT) scan. If the CT scan is
negative but a ruptured aneurysm is still
suspected based on clinical findings, a lumbar
puncture can be performed to detect blood in
the cerebrospinal fluid.

22. • Computed tomography angiography (CTA) is
an alternative to traditional angiography and
can be performed without the need for arterial
catheterization. This test combines a regular
CT scan with a contrast dye injected into a
vein. Once the dye is injected into a vein, it
travels to the cerebral arteries, and images are
created using a CT scan. These images show
exactly how blood flows into the brain arteries.

23. • X-rays to examine the inside of your body.
This allows your doctor to see the condition of
the blood vessels, as well as any blockages,
bulges, and weak spots that may be inside the
blood vessels.

24. MEDICAL
MANAGEMENT
• Pain relievers, such as acetaminophen
(Tylenol, others), may be used to treat
headache pain.
• Calcium channel blockers prevent calcium
from entering cells of the blood vessel walls.
These medications may lessen the erratic
narrowing of blood vessels (vasospasm) that
may be a complication of a ruptured aneurysm.

25. • One of these medications, nimodipine
(Nymalize, Nimotop), has been shown to
reduce the risk of delayed brain injury caused
by insufficient blood flow after subarachnoid
hemorrhage from a ruptured aneurysm.
• Interventions to prevent stroke from
insufficient blood flow include intravenous
injections of a drug called a vasopressor,
which elevates blood pressure to overcome the
resistance of narrowed blood vessels.

26. • Anti-seizure medications may be used to treat
seizures related to a ruptured aneurysm. These
medications include levetiracetam valproic
acid and others.

27. PROCEDURAL INTERVENE
1)An alternative intervention to prevent stroke is
angioplasty. In this procedure, a surgeon uses a
catheter to inflate a tiny balloon that expands a
narrowed blood vessel in the brain. A drug
known as a vasodilator also may be used to
expand blood vessels in the affected area.

28. • Ventricular or lumbar draining catheters and
shunt surgery can lessen pressure on the brain
from excess cerebrospinal fluid
(hydrocephalus) associated with a ruptured
aneurysm. A catheter may be placed in the
spaces filled with fluid inside of the brain
(ventricles) or surrounding your brain and
spinal cord to drain the excess fluid into an
external bag.

29. • Sometimes it may then be necessary to
introduce a shunt system — which consists of
a flexible silicone rubber tube (shunt) and a
valve — that creates a drainage channel
starting in your brain and ending in your
abdominal cavity.

30. SURGICAL MANAGEMENT
• Aneurysm Clips are used for surgical
procedure i.e. clipping of aneurysms, grafting
of aneurysms and flow diverters
There are currently two treatment options for
Intracranial aneurysms:
Surgical clipping
Endovascular coiling.

31. 1) 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. The surgical technique
has been modified and improved over the
years

33. 2) 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.

35. 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 ends.
• Less invasive endovascular techniques allow
covered metallic stent grafts to be inserted
through the arteries and fixation across the
aneurysm.

37. Flow diverters
• Newer treatments available for brain aneurysm
include flow diverters, tubular stent-like
implants that work by diverting blood flow
away from an aneurysm sac. The diversion
stops blood movement within the aneurysm
and so stimulates the body to heal the site,
encouraging reconstruction of the parent
artery. Flow diverters may be particularly
useful in larger aneurysms that can't be safely
treated with other options.

39. NURSES RESPONSIBILITY
• Pre-hospital care should include assessment of
vital signs and neurological status.
• If necessary, and establishment of intravenous
access.
• Treatment decisions should be based on the
clinical status of the patient
• Cardiac monitoring and placement of an
arterial line.
• Anticoagulation is avoided in this setting.

40. • Prior to definitive aneurysm treatment, medical
approaches involve control of hypertension,
administration of calcium channel blockers,
and prevention of seizures.
• Following surgical or endovascular aneurysm
treatment, blood pressure is maintained at
higher levels to diminish complications
• Induced hypertension, hypervolemia, and
hemodilution (Triple-H therapy) aimed to
maintain adequate cerebral perfusion pressure
• Pre and Post operative management.