Intro: This is BayCare HealthChat. Another podcast form BayCare Health System.

Amanda Wilde: Welcome to BayCare HealthChat. I'm Amanda Wilde. And in this episode, we'll look into the symptoms, causes and treatment of aortic aneurysms with Dr. Susan M. Shafii, vascular surgeon at BayCare. Dr. Shafii, thank you for being here.

Dr. Susan M. Shafii: Thank you for having me.

Amanda Wilde: I know aortic aneurysms can be life-threatening, but let's get our definitions straight. What exactly is an aortic aneurysm?

Dr. Susan M. Shafii: So the aorta is the main artery that comes out of your heart and feeds your entire body. And an aortic aneurysm is when the wall of the aorta becomes weak. And so there's three different layers to the aortic wall and in the infrarenal or below the kidney blood vessels, when the aneurysm grows in that location, that is what we technically can refer to as an aortic aneurysm. There's also aneurysms throughout the rest of the aorta that we can treat in different fashions, but the majority of aneurysms are below the renal arteries or the kidney blood vessels.

Amanda Wilde: And you said that's the more common aneurysm. How often do you see that, the most common kind of aneurysm?

Dr. Susan M. Shafii: So the patient population that traditionally shows up with an aortic aneurysm is usually somebody with a history of smoking, who is male and has Caucasian descent. It's so prevalent in that population, that part of your welcome to Medicare package if you do have the risk factors, which includes smoking in your past includes a screening aortic ultrasound to see if there is an aortic aneurysm to then follow.

Amanda Wilde: So if you have one, you may not even know you have it? Screening might find something that you aren't aware of?

Dr. Susan M. Shafii: Correct. Yes. Some people term them as the silent killer, but they are asymptomatic. And the only time they become symptomatic or cause symptoms is if they begin to leak or rupture and symptoms of leakage or rupture would include back pain or passing out with abdominal pain. Because the high risk of dying if it does get to that, we screen patients once they hit Medicare age, which is approximately 65 to 67.

Amanda Wilde: Does that mean anyone over 65 should get a preventive screening?

Dr. Susan M. Shafii: Not everyone, but it is part of the US Preventative Screening Task Force to obtain a single ultrasound, an aortic ultrasound, if you have had a history of smoking and you're a male.

Amanda Wilde: So those are the biggest risk factors. Are there any other risk factors to be aware of?

Dr. Susan M. Shafii: There are, if you have a genetic history or a family history of aneurysms in the past. If your parents died suddenly for an unknown reason. Aneurysms do tend to travel and certain families have aneurysms of different parts of their body. There is a genetic component in some families in which aneurysms present at a very young age. But for the majority of the population, if you do have a history of smoking that may be enough to screen for an aortic aneurysm. And the screening test is very simple. It's a quick ultrasound of the abdomen where you can actually look at the blood vessel, at the aorta, and they can measure the size of it.

Amanda Wilde: And then how often would you get these screenings, assuming you’re normal at the first one?

Dr. Susan M. Shafii: So if there's no sign of aneurysm at the screening ultrasound, then there's no need to follow it in the future. If they do see a small aneurysm, then usually we would follow you every year with an ultrasound until you hit a certain size. So your risk of aneurysm rupture or sudden death from an aortic aneurysm only increases with size of the aneurysm.

Amanda Wilde: So you can live with an aortic aneurysm?

Dr. Susan M. Shafii: Many people live with an aortic aneurysm. And traditionally, we don't offer surgery until they hit a certain size. If you're a male and you hit 5.5 to 6 centimeters, we offer you surgery at that time. We know that women who also have some risk factors, such as family history and smoking that do have aneurysms, we offer them surgery at five centimeters. That's because women tend to rupture or leak at a lower size range compared to men.

Amanda Wilde: So we're talking about surgery as a treatment option, but are there other treatment options or is surgery really the main way of treating aortic aneurysms?

Dr. Susan M. Shafii: So some people's aneurysms don't grow. Sometimes they stay the same. And you just want to make sure that you look at it every year or every six months to make sure it's not changing. The main treatment is to keep your blood pressure down. If you have uncontrolled high blood pressure, that aneurysm or like a balloon will continue to grow faster. So if you keep your blood pressure down, then technically your aneurysm may stabilize out. But if it is high, then it can grow faster for sure.

Amanda Wilde: Do they ever disappear?

Dr. Susan M. Shafii: They never go away completely. But the reason we don't offer surgery until you hit a certain size is because the risk of surgery is greater than your risk of rupture. So therefore, many people walk around with the aneurysms that won't rupture. And we only know they increase the risk of rupture when they hit a certain size.

Amanda Wilde: Someone that has been treated for aortic aneurysm through surgery or who has developed an aortic aneurysm that didn't go through surgery, are they more likely to develop more of these?

Dr. Susan M. Shafii: They can develop aneurysms throughout all of their major blood vessels. That is true. Once we fix one part of the aorta, such as below the kidney arteries, they can develop an aneurysm above that, depending on what their aorta is like and their genetic makeup and their blood pressure. Some people are prone to also get aneurysms behind the knees. We know that's called your popliteal artery, and we know that one-third of patients with an aortic aneurysm may get popliteal artery aneurysms as well.

Amanda Wilde: After hearing all this, if a person is concerned that they may have or develop aortic aneurysm, who should they go to? Primary care physician or a cardiologist or a different specialist?

Dr. Susan M. Shafii: Most patients can be screened safely by their primary care physician. If they order a screening aortic ultrasound in a vascular lab or a high-quality ultrasound lab with somebody who knows how to image the aorta, which is quite commonly imaged in ultrasound labs across the country, then that should suffice. If there's no aneurysm on that ultrasound image, then they can safely say there is no need for further imaging.

Amanda Wilde: But then you put one's mind at ease when you know what's going on there.

Dr. Susan M. Shafii: It's a screening ultrasound, which means that they quickly screen and scan the entire aorta to look for size measurements. So it's different than a diagnostic ultrasound or yearly aortic ultrasound. It's much like a screening mammogram where you screen quickly to see if there's anything abnormal, as opposed to a diagnostic mammogram, where we would diagnose if there's any need for further intervention.

Amanda Wilde: You know, I noticed that a lot of medicine is changing quite rapidly with the advances in technology. Is that happening too in the field of surgery and dealing with aortic aneurysms?

Dr. Susan M. Shafii: It is. We used to only offer open surgery for aortic aneurysms, and now we're able to place stents through the groin arteries and treat patients in a very quick, low profile technology action with minimal morbidity and mortality, meaning minimal overall risk. So it's very easy now to treat aortic aneurysms with stents alone as opposed to open surgery in the past.

In addition, the stents are advancing significantly as well. Before, we only used to be able to treat aneurysms up to the kidney arteries. And now, with the development of new grafts, we can treat aneurysms higher up, including all the blood vessels to the bowel and the liver and both kidney arteries. And those are much more complex to treat, but the technology has come a long way and we can treat a wide spectrum of patients now.

Amanda Wilde: Yeah. It sounds like you have advanced to less invasive and increasingly effective options.

Dr. Susan M. Shafii: Very much agree. They do need to undergo a routine imaging after the stents are placed and there may need to be some maintenance on the stents. But overall, your risk of rupture or death from the aortic aneurysm, if the stent goes in, is much lower.

Amanda Wilde: That is great to hear, because it's heartening to hear the treatment is available and aortic aneurysm doesn't have to be a killer.

Dr. Susan M. Shafii: Correct. The risk of death from aortic aneurysms is much lower now, since we've instituted the screening ultrasounds in the Medicare population compared to pre-screening for sure.

Amanda Wilde: And do you expect more great advances in the future?

Dr. Susan M. Shafii: I do. I expect that the stents that are available become more widely available across the country. Right now, the stents are still limited, but the pipeline of what I know is coming up within the next three to five years is going to really expand our ability to treat many more patients.

Amanda Wilde: Oh, that's great. Dr. Shafii, thank you for your insights and bringing us up-to-date so far in the care and treatment of aortic aneurysms.

Dr. Susan M. Shafii: Thank you for having me.

Amanda Wilde: And that wraps up this episode of BayCare HealthChat. To learn more about heart and vascular services offered at BayCare, visit BayCareHeart.org. Head on over to our website at BayCare.org for more information and to get connected with one of our providers.

Please remember to subscribe, rate and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels. And if you found this podcast informative, please share on your social media and make sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde. Until next time, stay well.