Definition:

Aneurysmectomy – is a procedure to remove an aneurysm in the aorta.

Aneurysm – are outpouchings or dilatations of the arterial wall and are a common problem involving the
aorta. (MedSurg 10th Ed. I. Collier and S. Lewis)

- An aneurysm is a localized sac or dilation formed at a weak point in the wall of the artery.
(MedSurg 12th Ed. Brunners and Suddarths)

Ectomy- means removal.

- This operation may be done to stop an aneurysm in the aorta from bursting.
- It may also be done to remove a ruptured aneurysm and repair the aorta.

Procedure:

Preoperative Procedure:

 Hydration and electrolyte balance

 Coagulation test
 Blood cell counts are corrected
 Antibiotic administration
 Enema
 Bath with antiseptic

However, if the aneurysm has ruptured, the treatment of choice is immediate surgical intervention.

Intraoperative Procedure:

 All aneurysm requires cross - clamping of the aorta proximal and distal to the aneurysm.
 -because this obstructs blood flow to the lower extremities.
 Before cross-clamping the blood is systematically anticoagulated with IV heparin.
- To prevent clotting of pooled blood distal to the aneurysm.
 Most resections can be completed in 30-45 minutes, after which time the clamps are removed
and blood flow to the lower extremities is restored.
 If the cross-clamp must be applied above the renal arteries, adequate renal perfusion after
removal of the clamp must be ascertained before closure of the incision.
 With saccular aneurysms, it may be possible to excise only the bulbous lesion, repairing the
artery by primary closure (suturing the artery together) or by application of an autogenous or
synthetic patch graft over the arterial defect.

Postoperative Procedure:

 All aneurysmectomy should be placed in ICU

 ETT
 NGT
 CVP
 PAC
 Peripheral IV lines
 Indwelling catheter
 CT- if the thorax is entered during surgery

Nsg. Consideration:

Preoperative:

 Assessment and nursing history

- Because most aneurysm are atherosclerotic and atherosclerosis is a systemic
disease process, it is likely that the present of throughout the body. Therefore, it
 is important for the nurse to watch for signs of cardiac, pulmonary, cerebral,
and peripheral vascular problems
 Monitor for signs of rupture of the aneurysm
- Manifestation of shock
a. Hypotension
b. tachypnea
c. Tachycardia
d. Pale clammy skin
e. Decreased UO
f. Altered sensorium
g. Abdominal tenderness on palpation
 Providing Support
 Teaching
 Providing baseline data
 Special attention should be paid to the character and quality of the peripheral pulses, voice and
the neurologic status

Postoperative:

 Monitor V/S
 Maintaining respiratory function
 Fluid and electrolyte balance to prevent hypovolemia
 Pain comfort
 Monitor graft patency
a. BP
b. Ventricular dysrhytmias
 Monitor renal perfusion and circulation
 Monitor CVP to assess client’s hydration
 Infection
a. Monitor WBC
b. Ensuring administration of broad-spectrum antibiotics as prescribed
c. Ensure adequate nutrition
d. Ensure serum albumin level to ensure proper wound healing
e. Monitor signs of infection
f. Maintain proper hygiene
g. Monitor for GI status
h. Monitor for neurological status
i. Monitor for circulatory status
j. Monitor for renal perfusion

Health teaching/ Discharged Plan

 Encouraged client to receive regular routine physical examinations

 Instruct client to report any symptom no matter how minor, must be investigated if it persists.
 Instruct the client to keep the incision site clean and dry
 Teach the client to report if signs of infection is present.
a. Fever
b. Swelling
c. Redness
d. Drainage
e. Odor
f. Separation of the wounds
 Instruct the client to lift nothing heavier than 5lbs. for about 6 – 12 weeks and to avoid driving
until permitted by the physician.
 To eat vitamin C rich food and high protein diet
 To adhere in treatment regimen
 To mobilize with assistance as tolerated