Abdominal Aortic Aneurysm Essay

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Definition An AAA (abdominal aortic aneurysm) is defined as enlargement of at least 3 cm of the abdominal aorta. The majority of abdominal aortic aneurysms begins below the renal arteries and ends above the iliac arteries. The exact cause of (AAAs) is unknown. However, it is thought to be due to a degenerative process of the abdominal aorta caused by atherosclerosis. Artherosclerosis represents a response to vessel wall injury caused by inflammation, genetically regulated defects in collagen and fibrillin, increased protease activity within the arterial wall, and mechanical factors (Stoelting p. 143). Pathophysiology The abdominal aorta consists of three distinct tissue layers including: the intima, media, and adventicia. There is…show more content…
There is an increase in the concentration of proteolytic enzymes compared to their inhibitors in the abdominal aorta as age progresses. It is also thought that metalloproteinases (MMPs) may be a factor in the development of AAAs (Stoelting p. 143). There is an increase in expression and activity of MMPs in people with AAAs. MMPs are present in normal aortic tissue and are responsible for vessel remodeling. These proteinases are secreted into the extracellular matrix of AAAs by aortic smooth muscle cells and macrophages. Increased MMP activity favors the degradation of collagen and elastin in aneurysmal tissue (Laake). Signs and Symptoms Patients with ruptured AAAs present in many different ways. The most common manifestation of rupture is back pain with a pulsatile abdominal mass and hypotension. Additional symptoms may include syncope, flank mass, groin pain, or paralysis (Dalman and White). Unstable patients with a suspected ruptured abdominal aortic aneurysm need immediate operation and control of the proximal aorta without preoperative confirmatory testing or optional volume resuscitation (Stoelting, p. 144). Anesthesia Management Surgical intervention is presently the only effective method of treating AAAs. The risk of surgical repair is outweighed by the risk of aneurysm rupture or aneurysm related death. Patients
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