Aortic Aneurysm Medical vs Surgical - Cleveland Clinic · PDF fileAortic Aneurysm Medical vs...

Aortic Aneurysm

Medical vs Surgical

Marian Soat RN MSN CCNS CCRN

Clinical Nurse Specialist

November 2014

Objectives

bull Discuss aortic aneurysm and the natural history of an aneurysm

bull Explain the pathophysiology of an aortic aneurysm

bull Discuss the difference between medical management and surgical interventions

bull Identify nursing considerations

Cleveland Clinic Heart and

Vascular Institute

bullHospital Tower

bull 288 Hospital Beds

bull 110 Critical care

Aortic Aneurysm

Definition

bull Permanent localized dilation of the aorta that is at least 50 larger in diameter than a normal aorta

bull The word aneurysm comes from the Greek aneurysma meaning a widening

wwwuthtmcedu

Aortic Aneurysm

bullEstimated 15 - 2 million people in the

US have an aortic aneurysm

bullThe primary cause of 10597 deaths

bullContributing cause in more than

17215 deaths

httpwwwcdcgov

Aortic Aneurysm

bull About two-thirds of people who have an aortic

aneurysm are male

bull The US Preventive Services Task Force

recommends that men aged 65 ndash 75 years who

have ever smoked

ndashShould be screened via ultrasound for abdominal

aortic aneurysms even if they have no symptoms

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

bullAbdominal Aortic

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Thoracic Aortic Aneurysms

bull Men and women are equally likely to

get thoracic aortic aneurysms

bull Thoracic aortic aneurysms are

usually caused by hypertension

bull May develop in individuals inherited

connective tissue disorders such as

Marfan syndrome

Thoracic aortic aneurysm

bull Signs and symptoms can include

ndash Sharp sudden pain in the chest or

upper back

ndash Shortness of breath

ndash Trouble breathing or swallowing

Abdominal Aortic Aneurysms

bull Abdominal aortic aneurysms highest

prevalence

bull Abdominal aortic aneurysms

ndash More common in men

ndash Among people aged 65 years and older

bull Abdominal aortic aneurysms may be

caused by atherosclerosis

bull Symptoms include

ndash Throbbing or deep pain in back or side

ndash Pain in the lower half of the body

Natural History

bull Aortic aneurysm will

expand with eventual

rupture

bull Some aneurysms

remain stable for

long periods of time

Natural History

bullSome aneurysms

enlarge quickly

bullRate of growth of

aneurysm is

unpredictable

Pathophysiology of Aortic

Aneurysm

bullThe underlying cause is

unknown in many

individuals

bullAtherosclerosis may

cause aneurysms

Aneurysm

bull Family clusters are suggestive of a genetic

predisposition

bull Hypertension

Marfan Syndromebull A disorder discovered in 1896

by a French doctor named Antoine Marfan

bull Symptomsndash Tall

ndash Long narrow face

ndash Long arms and legs

bull About 200000 Americans suffer from this disease

bull The disease is usually hereditary

AneurysmbullDegeneration of the arterial media

Aneurysm

bullArterial media is made

up of collagen and

elastin

bullCollagen and elastin are

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

AneurysmbullElastin has half

life of 40-70 yrs

bullElastin in normal

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Indications for Medical

Intervention

bull Lower risk for

rupture

bull lt 40 cm ndash annual

US and CT scan

bull 45 ndash 5 cm ndash

semiannual US and

Indication for Repair

bull 55 ndash 60 cm consider

elective repair

bull Increase in diameter

by more than 05 cm

within 6 month interval

Research

bull Two trials comparing EVAR to observation

for AAA lt55 cm

ndashFound no significant long-term differences

between AAA repair and medical management

bull In spite of the lower mortality rate

associated with EVAR

ndashThere appears to be no advantage to elective

EVAR repair for small and medium-sized

aneurysms

Endovascular repair compared with surveillance of aortic aneurysms Ouriel et al

Positive Impact of Endovascular Options for treating Aneurysms Early (PIVOTAL)

Vasc Surg 2010 May51(5)1081-7Epub 2010 Mar 20

Research

bull The randomized trials were comprised

predominately of men

bull For women a lower threshold of 5 cm may be

justified for elective repair of asymptomatic

ndashDue to the higher rate of rupture in women

compared with men for AAA of the same diameter

Should abdominal aortic aneurysm be managed differently in women

AULederle FASOScand J Surg 200897(2)125

Rapid Aneurysm Expansion

bull Earlier repair for rapid aneurysm

expansion

ndash gt05 cm in six months

bull Some data suggest that rapidly expanding

AAAs are more likely to have symptoms

bull Rapid expansion may represent instability

of the aortic wall and may be a sign of

impending aortic rupture

Clinical features and diagnosis of abdominal aortic aneurysm

uptodatecomm

Therapies to Limit Aortic Expansion

bullThe likelihood that an aneurysm will

expand or rupture is influenced by a

number of factors including

ndash Aneurysm diameter

ndash Rate of expansion

ndash Gender

ndash Ongoing smoking

Patient Age

bull Younger patients with AAA with a long life expectancy

will likely require repair at some point in their lives

bull The likelihood of needing surgery in the future for

medium-sized aneurysms (40 to 55 cm) is 50

percent at three years 60 to 65 percent at five years

and 70 to 75 percent at eight years

bull Older patients often die from associated illnesses prior

to expansion of the aneurysm to a size that would

indicate a need for repair

bull Continued observation in older patients may be

warranted for AAA that exceeds 55 cm

Systematic review repair of unruptured abdominal aortic aneurysm

Kane et al Intern Med 2007146(10)735

Pharmacologic Therapies

bull Many pharmacologic therapies aimed at

limiting AAA expansion and preventing

rupture have been tried

bull No pharmacologic therapy has been

proven successful at achieving these goals

bull Not recommended to implement any of the

pharmacologic therapies discussed for the

sole purpose of treating AAA

wwwuptodatecomcontentsmanagement-of-asymptomatic-abdominal-aortic-aneurysm

Cardiovascular Risk Reduction

bull Current multidisciplinary guidelines regard

AAA as a coronary heart disease

equivalent and recommend aspirin

bull There is no evidence to suggest that ASA

contributes to AAA expansion or rupture

bull Statins are recommended to reduce the

progression of atherosclerosis

uptodatecommanagement-of-asymptomatic-abdominal-aortic-aneurysm

bull Beta blocker therapy has a role in

managing patients with AAA

bull Beta blockers have not been clearly shown

to reduce aneurysm expansion rates

bull Two large trials found no significant

differences in AAA expansion rates in

patients receiving beta blockers compared

with those who did not

Uncertain Benefit of Beta-Blockers

Propranolol Aneurysm Trial Investigators J Vasc Surg 200235(1)72

ACE inhibitors and ARBs

bull A number of clinical studies have associated

reduced rates of expansion or rupture with the

use of angiotensin-converting-enzyme

inhibitors and Angiotensin II Receptor Blockers

bull Patients taking ACE inhibitors were significantly

less likely to present with ruptured aneurysm

compared with those who were not on ACE

inhibitors

Angiotensin-converting enzyme inhibitors and aortic rupture a population-based

case-control study Hackam DG Lancet 2006368(9536)659

Other Antihypertensives Agents

bull Diuretics and calcium channel blockers

have also been studied for their effects on

AAA expansion

bull Calcium channel blockers

ndashNo significant differences

bull Diuretics appear to have no impact on

expansion rates

Abdominal aortic aneurysm expansion risk factors and time intervals for surveillance

Brady AR Circulation 2004110(1)16

Potentially Beneficial Therapies

bullSmoking cessation ndash Cigarette smoking is the risk factor most strongly

associated with

ndash Aneurysm formation

ndash Aneurysm expansion

ndash Aneurysm rupture

ndash Is the most important modifiable risk factor in patients

with AAA

bullExercise ndash Higher levels of physical activity are associated with a

lower risk of cardiovascular morbidity and death

Medical Intervention

bull Do not let HR go less than 60

bull Keep BP less than 16090

bull Call for

ndash Systolic BP greater than 160

ndash Systolic BP less than 90

ndash Diastolic BP greater than 90

Pharmacologic Intervention

bull Hydralazine 10 mg

bull Route INTRAVENOUS

bull Freq EVERY 2 HOURS AS NEEDED

bull PRN Reasons Give for blood pressure

ndashSBP greater than 140 OR DBP greater

than 90

bull Metoprolol 10 mg injection (LOPRESSOR)

bull PRN Reasons Give for blood pressure of

bull PRN Comment SBP greater than 140 OR DBP

greater than 90 if HR greater than 60

bull Metoprolol tartrate (short acting) 125 mg tab(s)

(LOPRESSOR)

bull Admin Amount 1 tablet (1 times 125 mg tablet)

bull Route ORAL

bull Freq 2 TIMES DAILY

bull Admin Instruction HOLD FOR SBP lt 110 OR HR lt 60

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

bull2000 lives could

be saved if the

aorta is repaired

before rupture

Open Repair or Endovascular

Aneurysm Repair (EVAR)

bull Institution and

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

bullOpen repair for younger and healthier

patients

bullEVAR for older and more debilitated

patients

bullAnatomic considerations

bullPatient preference

Open Surgical Technique

bullMedian sternotomy

for ascending aorta

and arch

bullLeft thoracotomy

for descending aorta

bullAorta is cross clamped

bullDiseased portion of aorta is replaced with a Dacron or Teflon graft

bullGraft is sewn into place

Open Repair

bullRecovery is similar to

cardiac surgical

procedure

bullAdmitted to ICU for

1-3 days

bullRapid assessment in

the ICU is performed

by the nurse

Open Repair

bull If aortic valve is

involved bradycardia

or heart block may

ndashInflammation

ndashTrauma

ndashSutures close to the

conduction system

Open Repair

bullHypotension occurs often during

the first 12 hours after surgery

ndash As the patient warms

ndash As systemic vascular resistance

decreases to normal levels

Morbidity and Mortality Rates

bull Individuals more likely to experience serious

perioperative complications

ndash Patients with coronary artery disease

ndash Cigarette smokers with significant chronic

obstructive pulmonary disease

ndash Arrhythmias

ndash Pneumonia

ndash Older patients

ndash Female patients

ndash Renal dysfunction

Surgical Complications

bull Myocardial

infarction

bull Perioperative

bleeding

bull Graft infection

bull Renal failure

bull Colon ischemia

bull Wound infection

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

bullGrafts are durable

for 20-30 years

Endovascular Aneurysm Repair

bullEndo ndash within + Vascular ndash vessel

bullMinimally invasive technique

bullEVAR grafts have been used to

repair thoracic and abdominal

aneurysms

bullUse a metal stent covered with graft

material

bullThe stent is deployed inside the aorta

and held in place with metal hooks or

bullTransvascular

approach

bullFemoral incision

bull Insertion of a

bypass conduit

or endograft

Advantages of an Endovascular Repair

bullGood short term morbidity

and mortality rates

bullPatients who are too ill for

conventional surgery can be

considered for EVAR

bullBenefit is greatest for high risk

patients

EVARbullThe stent graft

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

ruptureBefore and after endovascular thoracic aortic aneurysm placement

photo courtesy of Joseph Bavaria MD

Advantages of an Endovascular

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

bullDecrease in total

hospital stay

Complications of Endovascular Repair

bullDamage to blood vessels or organs

bullDurability of endograft uncertain

bullPotential for graft migration

Complications of Endovascular

Repair

bull Endoleak

Endoleak is defined

as a persistent blood

flow outside the

lumen of the graft and

into the aneurysm

Spinal Complications

bull May cause paralysis

bull Due to hypotension

bull Due to inflammation

bull Hemorrhage

bull Fluctuations in BP

bull Decreased spinal

perfusion

Open Surgery vs Endovascular

Nursing Considerations

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bullLimb occlusion due to blockage of a blood vessel

Management of Complications

bull Temperature of extremities

bull Pulses

bull Color of extremities

bull Capillary refill

Summary

bullNatural history of an aneurysm

bullPathophysiology of aortic aneurysm

bullMedical management of aortic aneurysm

bullDifference between an open aneurysm

repair and endovascular repair

bullNursing considerations

Questions

Conclusion

bullTake your knowledge and skill

combine it with your compassion and

give all to your patient

Objectives

bull Discuss aortic aneurysm and the natural history of an aneurysm

bull Explain the pathophysiology of an aortic aneurysm

bull Discuss the difference between medical management and surgical interventions

bull Identify nursing considerations

Vascular Institute

bullHospital Tower

Aortic Aneurysm

Definition

wwwuthtmcedu

Aortic Aneurysm

17215 deaths

httpwwwcdcgov

Aortic Aneurysm

aneurysm are male

have ever smoked

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Vascular Institute

bullHospital Tower

Aortic Aneurysm

Definition

wwwuthtmcedu

Aortic Aneurysm

17215 deaths

httpwwwcdcgov

Aortic Aneurysm

aneurysm are male

have ever smoked

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aortic Aneurysm

Definition

wwwuthtmcedu

Aortic Aneurysm

17215 deaths

httpwwwcdcgov

Aortic Aneurysm

aneurysm are male

have ever smoked

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aortic Aneurysm

17215 deaths

httpwwwcdcgov

Aortic Aneurysm

aneurysm are male

have ever smoked

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aortic Aneurysm

aneurysm are male

have ever smoked

httpwwwcdcgov

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Common Sites

bullThoracic Aortic

aneurysm ~ 19

bullThoracic

Abdominal Aorta

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Common Sites

aneurysm ~ 65

aneurysm

associated with

iliac ~ 13

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Marfan syndrome

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

upper back

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

prevalence

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Natural History

rupture

bull Some aneurysms

remain stable for

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Natural History

bullSome aneurysms

enlarge quickly

aneurysm is

unpredictable

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

unknown in many

individuals

cause aneurysms

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

predisposition

bull Hypertension

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

up of collagen and

elastin

fibrous protein

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

bullCollagen

Responsible for the

mechanical

strength of vessel

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

bullElastin

Provides elasticity

to the vessel and

allows it to double

in diameter

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Aneurysm

bullThere is no

evidence that

elastin is

synthesized in

adult life

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

life of 40-70 yrs

vessel ~ 36

bullElastin in

aneurysmal

vessel ~ 8

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Rates of Rupture

bulllt 40 cm = low

bull40 - 49 cm = 5

bull50 - 59 cm = 25

bull60 - 69 cm = 35

bullge 70 cm = 75

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Intervention

bull Lower risk for

rupture

US and CT scan

semiannual US and

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

elective repair

by more than 05 cm

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Research

for AAA lt55 cm

aneurysms

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Research

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

expansion

uptodatecomm

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

ndash Gender

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Patient Age

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

inhibitors

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

AAA expansion

expansion rates

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

associated with

with AAA

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bull Call for

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

than 90

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

(LOPRESSOR)

bull Route ORAL

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bullWhen risk of

rupture is greater

than risk of

surgery

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bullWhen patient is

symptomatic

be saved if the

aorta is repaired

before rupture

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

physician

dependant

bullOpen repair is

more invasive

bullEVAR is less

invasive

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

patients

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

for ascending aorta

and arch

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Open Repair

cardiac surgical

procedure

1-3 days

by the nurse

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Open Repair

or heart block may

ndashInflammation

ndashTrauma

conduction system

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Open Repair

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

ndash Arrhythmias

ndash Pneumonia

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bull Myocardial

infarction

bull Perioperative

bleeding

bull Renal failure

bull Colon ischemia

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Surgical Outcomes

bullOpen surgical

repair has a 30 day

mortality rate of

for 20-30 years

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

aneurysms

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

material

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bullTransvascular

approach

bull Insertion of a

bypass conduit

or endograft

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

and mortality rates

considered for EVAR

patients

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

create a new

lining within the

aneurysm sac

bullReduce pressure

in the sac and

protect from

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Repair

httpwwwcodavisut

bullDecrease amount

of total blood loss

bullDecrease in

incidence of

cardiac and

respiratory events

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Repair

bull Increase in

patient

satisfaction and

comfort levels

hospital stay

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Repair

bull Endoleak

Endoleak is defined

flow outside the

into the aneurysm

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bull Hemorrhage

perfusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

Management of

Complications

bullEvaluate

bullCirculation

bullEdema

bull Pulses

Summary

Questions

Conclusion

bull Pulses

Summary

Questions

Conclusion

Summary

Questions

Conclusion

Questions

Conclusion

Aortic Aneurysm Medical vs Surgical - Cleveland Clinic · PDF fileAortic Aneurysm Medical vs...

Documents

Transcript of Aortic Aneurysm Medical vs Surgical - Cleveland Clinic · PDF fileAortic Aneurysm Medical vs...

Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic … · 2018-12-18 · Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic Aneurysm Şahin Bozok*, Sedat Ozan

Aortic Aneurysm

Aortic/Thoracic Aneurysm; Objectives Nursing Considerations · 252 - Aortic/Thoracic Aneurysm; Nursing Considerations - Soat Academy of Medical-Surgical Nurses (AMSN) 24th Annual

Idiopathic radial artery aneurysm: case report · aneurysm of the radial artery in a three-year-old child who was submitted to surgical resection after a complete diagnostic approach.

Nursing Aneurysm

Case Report - Hindawi Publishing Corporation · 2019. 7. 30. · Case Report Successful Surgical Treatment of an Infected Thoracoabdominal Aneurysm Accompanied with Leriche Syndrome

Clinical Study …downloads.hindawi.com/journals/tswj/2012/386478.pdfembolism during deep vein aneurysm surgical repair [2, 18] or when thrombosis recurred in venous surgical area.

Different Surgical Approach to Sacculer Renal Artery ... · by reviewing successful surgical repair of renal artery aneurysm and renal artery aneurysm in a 56-year-old woman who was

Joint Hospital Surgical Ground Round 17-7-2010 The Management of Mycotic Aneurysm Chan Hoi Yee Princess Margaret Hospital.

Surgeon Modified Fenestrated Endovascular Abdominal Aortic … · 2017. 1. 17. · comes for fenestrated endovascular aneurysm repair and open surgical repair of complex abdominal

The Brain Aneurysm Institute...Brain Aneurysm Institute Ajith J. Thomas, MD CO-DIRECTOR Brain Aneurysm Institute The Brain Aneurysm Institute Multidisciplinary Care of Patients with

Surgical Clipping of a Basilar Tip Aneurysm: Case …M. Kakou et al. 57 Brain CT angiography revealed a basilar tip aneurysm (Figure 2(a) and Fig-ure 2(b)) which presented with a height

Brain Aneurysm - Surgical Instruments and Medical Tools Aneurysm Patient Information Guide 4 What Is a Brain Aneurysm? A brain aneurysm is a balloon-like bulge in the wall of a brain

Pseudo Aneurysm

l-aneurysm-Clip - DB Surgical

Operative managements of extracranial carotid artery ......Keywords: Extracranial carotid artery aneurysm, Endovascular treatment, Surgical treatment, Willis covered stent Background

Ica aneurysm

Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm ...€¦ · Aneurysm Morphology Aneurysm anatomy refers to aneurysmal angle, presence of intraluminal mural thrombus, and

Endovascular aortic aneurysm repair with carbon dioxide ... EVAR J of Vasc Surg.pdf · From the Midwestern Vascular Surgical Society Endovascular aortic aneurysm repair with carbon

Giant Intracranial Aneurysms - Surgical Treatment ... · aneurysms (Yasargil, 1984). If the widest diameter of the aneurysm is equal to or exceeding 25 millimetres (mm), the aneurysm