Celiac Trunk Aneurysm

　　One, etiology of the disease

　　Six, Treatment: The treatment of abdominal aorta aneurysm includes conservative treatment and surgical treatment. Conservative treatment includes medication and lifestyle changes, while surgical treatment includes open surgery and endovascular intervention.

　　Five, Diagnosis: The diagnosis of abdominal aorta aneurysm mainly relies on imaging examinations such as CT and MRI.

　　The complications of abdominal aorta aneurysm can lead to severe symptoms such as abdominal pain, back pain, and shock, and can even cause death.

　　Two, Pathogenesis: The etiology of this disease is not fully understood at present. It is believed that the common cause of celiac trunk aneurysm is the medial degeneration associated with atherosclerosis, followed by trauma, infection, and congenital factors. Syphilis can also directly cause damage to the artery, but it is only occasionally reported.The abdominal aorta aneurysm mainly involves the distal part of the celiac trunk artery, usually being a cystic aneurysm.

　　21, Arterial aneurysm: What complications can an abdominal aorta aneurysm easily lead to

　　2, Cerebral vasospasm: Re破裂 is a severe complication of intravascular embolization, caused by abrupt blood pressure fluctuations, mechanical stimulation during surgery, and changes in the coagulation mechanism due to anticoagulant treatment after surgery. The rupture of the aneurysm and mortality rate increase with age. The patient may suddenly appear with anxiety, a painful expression, restlessness, severe headache, varying degrees of consciousness disorders, and urinary incontinence. Emergency CT shows subarachnoid hemorrhage, and lumbar puncture shows bloody cerebrospinal fluid. The nurse must carefully observe the patient at all times, promptly detect and notify the doctor for timely treatment. After surgery, the patient should be carefully observed in the neurosurgical ICU for changes in consciousness, pupil changes, limb movement, vital signs, especially blood pressure and respiratory changes. For patients with high blood pressure, control the blood pressure to around 16/11Kpa. For conscious patients, instruct them to stay in bed for 48 to 72 hours, avoid vigorous movement of the head within 48 hours, maintain emotional stability, and ensure smooth defecation.3, Hematoma at the puncture site: It is a common complication after intracranial aneurysm embolization. If the patient experiences transient neurological dysfunction, such as headache, blood pressure drop, brief loss of consciousness, and limb paralysis, it may be due to cerebral vasospasm. It is necessary to report to the doctor immediately for expansion and antispasm treatment. Continuous low-flow oxygen therapy should be provided to improve brain tissue hypoxia. The nurse should pay special attention to changes in neurological symptoms and provide psychological care for the patient. Vasospasm caused by angiography and embolization can last for 3 to 4 weeks, and nimodipine is commonly used in clinical practice to prevent cerebral vasospasm. Nimodipine is a highly selective calcium ion antagonist acting on the brain tissue, which can directly dilate cerebral blood vessels, increase cerebral blood flow, and also act on neuron cells to enhance their ability to resist ischemia and hypoxia, accelerate the recovery of normal physiological activity. When using nimodipine, it is necessary to closely monitor heart rate and blood pressure changes, and if symptoms such as blood pressure drop, flushing, palpitations occur, the infusion rate should be slowed down or the medication should be discontinued. At the same time, fluid replacement, expansion, and supportive treatment should be provided.

　　4, Cerebral infarction: Hematomas are prone to occur within 6 hours after surgery, due to poor elasticity of arterial vessels, excessive heparin during surgery, or disorders of the coagulation mechanism. Frequent movement of the punctured limb, uneven pressure on the local area, and other factors can contribute. The main symptoms include local swelling and ecchymosis. After the patient safely returns to the ward after surgery, it is essential to advise the patient to lie flat for 24 hours, apply a sandbag pressure for 6 hours at the wound site, and prohibit flexion and immobilization of the lower limb on the side of the puncture site. Always observe for local bleeding and hematoma at the puncture site. Small hematomas generally do not require treatment and can resolve spontaneously after a few days. If bleeding is severe, blood pressure drops, and a large hematoma occurs, in addition to compressing the femoral artery and applying pressure bandages, local heat can be applied after 24 hours, elevate the foot to promote venous return, and pay attention to the patient's dorsalis pedis artery pulsation.The formation of postoperative thrombosis or thromboembolism causing cerebral infarction is one of the complications of surgery. Severe cases may die due to cerebral artery occlusion and ischemic brain tissue. Early and close observation of changes in language, motor, and sensory functions should be made after surgery, and regular communication with the patient should be maintained to detect changes in the condition early. If hemiparesis, hemiplegia, aphasia, or even unconsciousness occurs on one side of the body after surgery, the possibility of cerebral infarction should be considered, and the doctor should be notified immediately for timely treatment. After surgery, the patient is in a hypercoagulable state, and routine short-term 48-hour heparinization is given, combined with long-term aspirin treatment to prevent cerebral infarction. During treatment, it is important to closely observe for signs of bleeding, measure blood pressure every 10 to 30 minutes, and record it in detail. Observe for bleeding spots in the gums, conjunctiva, and skin, the color of urine and stool, and symptoms of intracranial hemorrhage such as headache and vomiting.

　　5. Lower limb thromboembolism:During treatment, varying degrees of endothelial damage to blood vessels can cause the formation of lower limb arterial thrombosis. This may manifest as varying degrees of cyanosis of the skin on the surgical side of the lower limb or significant pain in the lower limb, with the pulse of the dorsal foot artery significantly weaker than that on the contralateral side, suggesting the possibility of lower limb embolism. After surgery, touch the dorsal foot artery once every 15 to 30 minutes to observe the peripheral circulation of the lower limb, such as whether the pulse of the dorsal foot artery is weakened or disappeared, and whether the skin color, temperature, and pain sensation are normal. Due to the hypercoagulable state of the patient after surgery, paralysis of the limbs, nervousness, and lack of appropriate activity, if lower limb venous thrombosis occurs, instruct the patient to stay in bed absolutely, elevate the limbs, facilitate venous return, limit limb movement, and follow the doctor's advice to administer thrombolytic and anticoagulant drugs.

　　6. Delayed allergic reactions:Allergic reactions are prone to occur when using ionic contrast agents, but some patients may still experience allergic phenomena even when using non-ionic contrast agents. When contrast agents enter the human body for a long time and in large doses, allergic symptoms may occur. Mild allergic reactions may include headache, nausea, vomiting, skin itching, urticaria, etc., while severe cases may present with shock, respiratory distress, tetany, and so on. Therefore, it is important to closely observe changes in the condition and be familiar with the treatment of contrast agent allergic reactions.

　　7. Hydrocephalus:It is the most common complication after aneurysm surgery. Acute hydrocephalus can be resolved by performing external ventricular drainage at the same time as the surgery, while chronic hydrocephalus requires surgical shunting.

　　Most abdominal aorta aneurysms have no symptoms, while a few may manifest as upper abdominal pain and discomfort radiating to the back, often mistaken for pancreatitis or peptic ulcer disease. In 1976, Haimovici et al. reported a case of abdominal aorta aneurysm with symptoms similar to those of ulcer disease, leading to partial gastrectomy. The abdominal pain did not subside until the aneurysm was removed. The rupture of the aneurysm caused bleeding within the celiac trunk, first entering the lesser omentum sac, then the peritoneal cavity. At this time, upper abdominal pain accompanied by nausea and vomiting, back pain, pulsating mass, gastrointestinal bleeding, shock, and occasionally obstructive jaundice may occur, which are often manifestations of abdominal aorta aneurysm rupture.

　　1. Pay attention to appropriate exercise

　　To prevent aneurysms, one should pay attention to appropriate exercise, physical exercise, and strengthen physical fitness. An aneurysm may be caused by trauma, and by maintaining good physical fitness, the chance of trauma infection can be reduced.

　　2. Pay attention to mental adjustment

　　To prevent aneurysms, friends should also pay attention to mental adjustment in daily life. They should maintain a peaceful mindset, not be easily irritable, and face life with a good attitude, which is helpful for the prevention of diseases throughout the body.

　　3. Pay attention to dietary issues

　　To prevent aneurysms, friends should not neglect dietary issues in daily life. In daily life, they should eat more soy products, avoid high-fat, high-sugar, and high-salt diets. They can eat more fresh vegetables and fruits, eat more fish, as fish helps to relax arteries and is beneficial for the prevention of aneurysms.

　　Ultrasound, SCTA, MRA are of great help in diagnosis. Due to the wide application of angiography or DSA, the discovery of celiac trunk aneurysms is increasing day by day. Angiography and DSA are the most reliable means of diagnosing celiac artery aneurysms.

　　1. The diet should mainly consist of light foods, pay attention to dietary regularity.

　　2. Follow a reasonable diet according to the doctor's advice.

　　3. There are no great taboos for this disease in diet, a reasonable diet is enough.

　　Currently, it is advocated that all patients with celiac trunk aneurysms who can tolerate surgery should undergo surgical treatment.

　　1. Surgical approach:For ruptured or impending ruptured celiac trunk aneurysms, a good surgical field can be obtained by performing a thoracoabdominal incision through the left anterior axillary line and the 7th intercostal space followed by a median abdominal incision. For most non-ruptured celiac trunk aneurysms, abdominal resection can be adopted.

　　2. Surgical methods:It mainly depends on the size and location of the aneurysm. If the proximal and distal vessels are normal and have sufficient length after the aneurysm is removed, direct end-to-end anastomosis can be performed; if the length is insufficient, after the tumor is removed, autologous great saphenous vein or artificial blood vessels can be used for interposition transplantation reconstruction between the abdominal aorta and the celiac artery. According to literature reports, more than 35% of patients can undergo aneurysm resection and celiac trunk ligation without causing liver necrosis. The celiac artery aneurysm often compresses the splenic vein, and clinical signs of portal hypertension and highly dilated splenic vein should be noted.

　　Since the abdominal aorta aneurysm is often accompanied by other obstructive arterial diseases or aneurysms, postoperative monitoring should be strengthened.