Endovascular leaks: perioperative nursing implications.

Endovascular repair is becoming the gold standard treatment for aortic aneurysm disease. With the development of new treatment modalities, however, new and unique complications arise. Endovascular stent graft leaks (ie, endoleaks) are one such complication. Endoleaks occur when blood leaks into the aneurysm sac after an endovascular stent repair. Endoleaks are divided into four categories (ie, I through IV) depending on the site of origin; perioperative nurses must become familiar with treatment options for each type of endoleak.

The modified Bentall procedure for aortic root replacement.

The Bentall procedure is a surgical repair of an ascending aortic or aortic root aneurysm in combination with aortic valve disease. Less commonly, it is used to repair aortic dissection affecting the aortic root and valve. During the procedure, a composite aortic valve graft is used to replace the proximal ascending aorta and aortic valve. The procedure is performed through a median sternotomy during cardiopulmonary bypass. In this modification of the original procedure, coronary artery circulation is maintained by removing a full-thickness "button" of aorta surrounding the coronary ostia, making it easier to implant the proximal end of the coronary arteries into openings made in the aortic vascular graft.

Intrapartum care of a woman with aortic aneurysms.

Advances in technology and complex care have enabled women with various health problems to become and remain pregnant. Consequently, health-care practitioners are seeing an increasing number of pregnant women who have aortic aneurysms. This case study describes the culturally sensitive intrapartum care of a Middle Eastern woman with ascending and descending aortic aneurysms.

Naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms.

The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. Critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. Critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.

Traumatic descending thoracic aneurysms: discussion and nursing care.

Traumatic aneurysms of the descending thoracic aorta are a rare but lethal event, having a mortality of 85-90%. Mortality of this population remains high due to the occurrence of aortic rupture. The isthmus of the aorta, just distal to the left subclavian artery is the most frequent site of injury. Acute traumatic injury to the aorta is characterized by hemorrhagic shock symptoms due to the tear in the layers of the aortic wall. Chronic traumatic injury with aneurysmal formation may not surface with symptoms for months or years after initial trauma. Patients who have formed a chronic aneurysm after a trauma incident can experience dysphagia, chest pain, dyspnea, or cough. Surgical repair involves placing a dacron graft in the area of aneurysmal formation. Protection of the lower extremities during the surgical procedure may prevent paraplegia. In a review of ten cases of chronic traumatic aneurysms at Loyola University Medical Center during the past twenty (20) years, all patients underwent surgical repair. There was no incidence of paraplegia. Post-operative nursing care focuses on monitoring hemodynamic stability, preventing respiratory complications and controlling pain.

Ascending aortic arch aneurysms and dissections: discussion and nursing management.

Ascending aortic arch aneurysms and aortic dissections are serious conditions with high mortality and morbidity. Aneurysms can be defined according to morphology or location and are usually precipitated by atherosclerosis or cystic medial necrosis. Intact aortic aneurysms are often asymptomatic, while chest pain is frequently the predominant symptom associated with aortic dissections. The diverse clinical presentation of aneurysms and dissections makes diagnosis difficult. When the aneurysm is large or the patient is symptomatic, surgical intervention is the preferred treatment and consists of replacing a segment of the aorta with a synthetic graft. Postoperative nursing care focuses on altered tissue perfusion, fluid volume deficit, potential respiratory insufficiency and patient teaching.

Marfan's syndrome. A personal perspective.

Marfan's patients share the same problems as anyone with a lifelong, progressive, hereditary condition. The more knowledgeable an individual is about his disease and the more willing he is to accept the responsibility for his own well-being, the more control he has over his life. Medical and life insurance is not a luxury, but an absolute must. The need for stable insurance coverage impacts career decisions. Medication is a lifelong necessity; the patient must know what medications he takes, for what purpose, and the side effects. For patients with a cardiac prosthesis, most physicians recommend a regimen of prophylactic antibiotics before dental work or any invasive procedure. It is the responsibility of the patient to do this. Craig has cancelled dental appointments because he has forgotten to take antibiotics. Craig also takes an anticoagulant because of his prosthetic valve and fears being in a major accident and bleeding to death. Because of human body contains large amounts of connective tissue, a Marfan's patient will continue to develop problems; hernias, eye problems, joint problems, and further cardiovascular complications are all possibilities. Being realistic and maintaining a positive attitude are important in effective planning and dealing with continued adversity.

Marfan's syndrome and surgical repair of ascending aortic aneurysms.

Marfan's syndrome is an inherited, degenerative connective tissue disorder that affects many body systems (eg, skeletal, ocular, cardiovascular, cutaneous, pulmonary, abdominal, neurologic). The cause of Marfan's syndrome is unknown, but recent genetic studies have linked this disorder to chromosome 15q15-q21.3. The characteristics associated with Marfan's syndrome require a multidisciplinary approach to patient care. This article discusses one serious complication of Marfan's syndrome-aortic root dilatation- and composite graft repairs of ascending aortic aneurysms. Physicians and nurses must be more aware of Marfan's syndrome so that life-threatening medical conditions can be evaluated and followed by health care providers.

Thoracic aortic dissection: preventing complications.

The patient who is admitted to the intensive care unit (ICU) with an acute thoracic aortic dissection represents a nursing emergency. Through astute nursing actions, most complications can be prevented for those patients who have aortic wall injury due to trauma or medical conditions.