Aortic Aneurysms: An Overview from a Vascular Surgeon
Dr. Vasquez discusses aortic aneurysms and the various symptoms and treatments.
Featured Speaker:
Javier "Jay" Vasquez, MD
Dr. Jay Vasquez, Medical Director for Surgical Services and vascular surgeon on the medical staff at Baylor Scott & White Heart and Vascular Hospital Dallas and Baylor University Medical Center. Dr. Vasquez is on the multidisciplinary team of the Aortic Center at Baylor Scott & White Heart and Vascular Hospital Dallas. Dr. Vasquez is also a faculty member involved in the nationally recognized vascular fellowship program at Baylor University Medical Center. Transcription:
Aortic Aneurysms: An Overview from a Vascular Surgeon
Bill Klaproth: Aneurysms occur most commonly in the brain. However, they can also occur in the chest called a thoracic aortic aneurysm or in the abdomen called an abdominal aortic aneurysm. So what are their prevalence? What are the signs and symptoms, what are the treatment options, and how can you lower your risk factors associated with aortic aneurysms? Well, let's find out from a vascular surgeon. Joining us is Dr. Jay Vasquez, Medical Director for Surgical Services and Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas and Baylor University Medical Center. Dr. Vasquez is also on the multidisciplinary team of the Aortic Center at Baylor Scott and White Heart and Vascular Hospital Dallas. This is Heart Speak with Baylor Scott and White heart and Vascular Hospital in Dallas in Fort Worth. I'm Bill Klaproth. Dr. Vasquez, thanks so much for your time. So is it true that aneurysms are more common in men over the age of 65 but they can occur at any age?
Dr. Vasquez: Oh, that's correct. The most common age range is definitely from 65 onwards. But they can rarely occur in a younger population, but most definitely the most common age range is in that post 65 year old range.
Host: So as we talk about thoracic and abdominal aortic aneurysms, what is the aorta and what is its function?
Dr. Vasquez: So the aorta is the biggest artery in our body. It starts at the heart and goes up, down our chest and into our abdomen. It provides the blood supply to all of our organs. So everything in the body that needs oxygen, which is everything is supplied by the aorta and its branches.
Host: So in other words, it is the major pipeline for blood in our bodies.
Dr. Vasquez: It is the main highway with all of the off roads representing blood vessels that feed all of our organs from our upper extremities, our brain, our liver, our kidneys, and our legs.
Host: So then what happens? What is an aortic aneurysm?
Dr. Vasquez: So an aneurysm is basically a dilation of a blood vessel. It's an abnormal ballooning of an artery. We all know that can occur anywhere in our body. We hear about brain aneurysms very commonly, but it really occurs anywhere. For today's discussion, we're talking about aneurysms that occur in this main highway and it's basically, we know it's a weakening of the muscle wall of the artery. So the artery is a tube, but within the wall of that tube is a muscular layer that we know somehow gets weakened. And in the process of the lifetime where it's subjected to blood pressure and the constant beating of the heart, it slowly begins to dilate, abnormally, can balloon out and that becomes an aneurysm.
Host: And then how common are aortic aneurysm?
Dr. Vasquez: In the United States, about 10,000 people die from an aneurysm annually, it's about the 13th leading cause of death in the US. And so it is prevalent and again occurs in the age range over the age of 65, more commonly in men, but can occur in both genders.
Host: So what are the reasons or the factors that potentially build up and lead to an aortic aneurysm?
Dr. Vasquez: We know it's a weakening of the arterial muscle wall. We know there's some genetic component to that in terms of our everyday lifestyle that can contribute negatively impact the aorta in a negative way is obviously high blood pressure, high cholesterol, and smoking. There's a definitive correlation between a smoking history and the development of an aortic aneurysm. It's so much so that if the current recommendation is if you ever had a history of smoking in your life and you've reached the age of 60, it's recommended that you undergo a screening ultrasound to see if you have any aortic aneurysm.
Host: Wow, that's really interesting. So since we're unable to see this weakening or the ballooning, as you call it, are there symptoms for thoracic aortic aneurysms and are there symptoms for abdominal aortic aneurysms?
Dr. Vasquez: Yes there are. And basically they're the same symptom. It's pain. And so as the artery starts to dilate and become larger, it stretches and there are some nerve endings within the muscle and within the wall of the artery that you will feel. And then other adjacent structures of the aorta begins to impinge on can also lead to pain. So the most common symptom for a thoracic aorta aneurysm is that has become symptomatic is for the most part, upper back pain and chest pain for an abdominal aortic aneurism, it's abdominal pain or back pain, you have to remember that within the abdomen and within the chest as well, the aorta sits very close, if not directly on top of the vertebrae of our back. And so that's what causes that back pain is that continuous pressure and pulsation against the backbone. And that's what leads to that symptom.
Host: So we all have back pain now and then we all have stomach pain now and then, gosh, what did I eat last night? I mean, right. How do you know when it's time to see the doctor?
Dr. Vasquez: That's a very good point. I mean, lower back pain is a very common ailment us here in this country and around the world. And so this will be a very distinct pain, that for the most part, in my experience, I've noticed that patients are able to tell the difference. It is not your same run of the mill, I picked something up and I hurt my back, I tweaked my back doing such and such. This is a very distinct, deep seated pain that you'll be able to tell the difference between your everyday back pain and is this possibly an aneurysm. Now of course back pain can change and I don't want to instill fear in every time you have a back pain you have an aneurysm. But for the most part you'll know is a different type of pain and usually comes along with abdominal pain for an abdominal aneurysm. So it's sort of a constellation of things that definitely is distinctively different from your everyday back pain.
Host: Okay, so there are warning signs, which is good to know and that we should all pay attention to. So then what typically happens when a patient has an aortic aneurysm?
Dr. Vasquez: Well, honestly, very typically they're not symptomatic. Patients don't know they have an aneurysm. I would say for the most part, our patients that come and see us for aneurysms, these things were found incidentally from a CAT scan. The most common scenario is a patient went to the emergency room for some other ailment, underwent some kind of imaging, most likely a CT scan. And lo and behold, there's an aneurysm. And then they get referred to us for workup. So it's really mostly a problem that doesn't have symptoms and is usually found just incidentally when someone goes and visits their primary care doctor or has an emergency room visit where they did a CT scan. Once the patient has symptoms, however, it's a little bit more urgent. And then that changes sort of the algorithm of how we treat them.
Host: So you just mentioned referred to you. Can we talk about the aortic center for a minute? Can you tell us about it and what specialists are involved?
Dr. Vasquez: We realize that aortic disease and the treatment of aortic patients is very complex. Like I said earlier, it is the main artery in our body. So it's a very complex process that requires a multidisciplinary approach for the best outcomes. Here at the Aortic Center, we have a cardiothoracic team and a vascular surgery team, as well as a cardiology team that sees the patient assesses the whole patient, their cardiac function. Do we have to fix the aneurysm, how we're going to fix the aneurysm, what's the best approach? And so we feel that this multidisciplinary approach provides a better consensus and a better plan that leads, we hope to a better outcome for the patient.
Host: So let's talk a little bit more about that approach. So then, what are the typical steps once a patient consults with you?
Dr. Vasquez: So the patient will come into the aortic center, they'll get checked in. They'll be placed into an exam room. Myself or another vascular surgeon along with our cardiothoracic surgeons will examine the patient, review the films with the patient, go over with them. It's very important to go through the images with the patients, show them where the aneurysm is. It kind of helps, you know, they say a picture's worth a thousand words and that really is true because it's really good to go through the imaging with them because they get, they are able to grasp the idea of what this is and how we're going to fix it. Once we examine the patient and go through the images, then we'll sort of sit down as a team and decide, okay, what is the best next step for this patient? How are we going to approach it? How are we going to fix it? And there's multiple different ways we can do it. And so once we become, once we have that consensus between all of us, then the patient isn't scheduled for the procedure if necessary. A lot of times they don't need a procedure and they come in and they've been diagnosed with the aneurysm, but it doesn't need treatment right now. And then they get into a surveillance program with the Aortic Center.
Host: So let's talk about that treatment. What is treatment for an aortic aneurysm?
Dr. Vasquez: Well, there's two basic ways to treat the aneurysm. One is with an endovascular approach. What does that mean? That means that we are inserting a stent within the aorta. That excludes the blood flow from entering the aneurysm. The biggest risk for an aneurysm is that it ruptures. That's the reason why patients could die from an aneurysm. A stent graph goes inside the aorta and now diverts the blood away from the aneurysm, allowing it to shrink away and not become an issue. The second way we treat aneurysms is with open surgery. There are certain anatomic restrictions that this particular aneurysm may not be able to get a stent and then we have to perform open surgery to replace the aorta.
Host: So are there ways to lower risk factors associated with aortic aneurysms?
Dr. Vasquez: You know, there's a lot of things we can do in terms of lifestyle and you know, we all know what they are, but definitely a healthy eating habits and controlling your blood pressure are paramount. The most important thing, however, is to not become a smoker. And if you are a smoker to stop, we know there is a direct correlation between smoking and aneurysm formation and aneurysm rupture. So I would say the best thing to do would be control your blood pressure. Become a nonsmoker or stay a nonsmoker is your best chance of never having to deal with this.
Host: That is great advice. You know we always hear no your numbers. We should all know our numbers. Well, you should certainly know your cholesterol numbers and your blood pressure numbers. Those are really two important numbers to know when it comes to aortic aneurysm.
Dr. Vasquez: Absolutely, and you know the blood pressure makes sense. If it's the main artery in your body, it is basically under the pressure of your constant blood pressure, every beat of your heart and so it makes sense that the higher your blood pressure, the more pressure on the wall of the aorta, which then leads to this dilation and aneurysm formation. The important thing I want to emphasize on blood pressure is you don't feel high blood pressure for a very long time so it's very important to check with your primary care physician, know your number though, whether or not you need to be treated and what's the best treatment you can start to get that blood pressure within normal range.
Host: Really, really important things to remember and try to put into place and for someone listening. If you're looking for a hospital and or specialist, the Aortic Center at Baylor Scott and White Heart and Vascular Hospital Dallas can be reached by calling 214-820-4876, 214-820-4876. You can also send an email to dallasaorticcenteratbswhealth.org. And that information will be in the transcript for this podcast, Dr. Vasquez, this has really been interesting and informative. Thank you for your time.
Dr. Vasquez: Thank you. I appreciate you having me.
Host: That's Dr. Jay Vasquez, Medical Director for Surgical Services and Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas and Baylor University Medical Center. And thanks for checking out this episode of Heart Speak, to find a specialist on the medical staff once again call (214) 820-4876 you can also visit BaylorHeartHospital.com/aorticcenter. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for listening. Baylor Scott and White Heart and Vascular Hospital Dallas and Fort Worth joint ownership with physicians.
Aortic Aneurysms: An Overview from a Vascular Surgeon
Bill Klaproth: Aneurysms occur most commonly in the brain. However, they can also occur in the chest called a thoracic aortic aneurysm or in the abdomen called an abdominal aortic aneurysm. So what are their prevalence? What are the signs and symptoms, what are the treatment options, and how can you lower your risk factors associated with aortic aneurysms? Well, let's find out from a vascular surgeon. Joining us is Dr. Jay Vasquez, Medical Director for Surgical Services and Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas and Baylor University Medical Center. Dr. Vasquez is also on the multidisciplinary team of the Aortic Center at Baylor Scott and White Heart and Vascular Hospital Dallas. This is Heart Speak with Baylor Scott and White heart and Vascular Hospital in Dallas in Fort Worth. I'm Bill Klaproth. Dr. Vasquez, thanks so much for your time. So is it true that aneurysms are more common in men over the age of 65 but they can occur at any age?
Dr. Vasquez: Oh, that's correct. The most common age range is definitely from 65 onwards. But they can rarely occur in a younger population, but most definitely the most common age range is in that post 65 year old range.
Host: So as we talk about thoracic and abdominal aortic aneurysms, what is the aorta and what is its function?
Dr. Vasquez: So the aorta is the biggest artery in our body. It starts at the heart and goes up, down our chest and into our abdomen. It provides the blood supply to all of our organs. So everything in the body that needs oxygen, which is everything is supplied by the aorta and its branches.
Host: So in other words, it is the major pipeline for blood in our bodies.
Dr. Vasquez: It is the main highway with all of the off roads representing blood vessels that feed all of our organs from our upper extremities, our brain, our liver, our kidneys, and our legs.
Host: So then what happens? What is an aortic aneurysm?
Dr. Vasquez: So an aneurysm is basically a dilation of a blood vessel. It's an abnormal ballooning of an artery. We all know that can occur anywhere in our body. We hear about brain aneurysms very commonly, but it really occurs anywhere. For today's discussion, we're talking about aneurysms that occur in this main highway and it's basically, we know it's a weakening of the muscle wall of the artery. So the artery is a tube, but within the wall of that tube is a muscular layer that we know somehow gets weakened. And in the process of the lifetime where it's subjected to blood pressure and the constant beating of the heart, it slowly begins to dilate, abnormally, can balloon out and that becomes an aneurysm.
Host: And then how common are aortic aneurysm?
Dr. Vasquez: In the United States, about 10,000 people die from an aneurysm annually, it's about the 13th leading cause of death in the US. And so it is prevalent and again occurs in the age range over the age of 65, more commonly in men, but can occur in both genders.
Host: So what are the reasons or the factors that potentially build up and lead to an aortic aneurysm?
Dr. Vasquez: We know it's a weakening of the arterial muscle wall. We know there's some genetic component to that in terms of our everyday lifestyle that can contribute negatively impact the aorta in a negative way is obviously high blood pressure, high cholesterol, and smoking. There's a definitive correlation between a smoking history and the development of an aortic aneurysm. It's so much so that if the current recommendation is if you ever had a history of smoking in your life and you've reached the age of 60, it's recommended that you undergo a screening ultrasound to see if you have any aortic aneurysm.
Host: Wow, that's really interesting. So since we're unable to see this weakening or the ballooning, as you call it, are there symptoms for thoracic aortic aneurysms and are there symptoms for abdominal aortic aneurysms?
Dr. Vasquez: Yes there are. And basically they're the same symptom. It's pain. And so as the artery starts to dilate and become larger, it stretches and there are some nerve endings within the muscle and within the wall of the artery that you will feel. And then other adjacent structures of the aorta begins to impinge on can also lead to pain. So the most common symptom for a thoracic aorta aneurysm is that has become symptomatic is for the most part, upper back pain and chest pain for an abdominal aortic aneurism, it's abdominal pain or back pain, you have to remember that within the abdomen and within the chest as well, the aorta sits very close, if not directly on top of the vertebrae of our back. And so that's what causes that back pain is that continuous pressure and pulsation against the backbone. And that's what leads to that symptom.
Host: So we all have back pain now and then we all have stomach pain now and then, gosh, what did I eat last night? I mean, right. How do you know when it's time to see the doctor?
Dr. Vasquez: That's a very good point. I mean, lower back pain is a very common ailment us here in this country and around the world. And so this will be a very distinct pain, that for the most part, in my experience, I've noticed that patients are able to tell the difference. It is not your same run of the mill, I picked something up and I hurt my back, I tweaked my back doing such and such. This is a very distinct, deep seated pain that you'll be able to tell the difference between your everyday back pain and is this possibly an aneurysm. Now of course back pain can change and I don't want to instill fear in every time you have a back pain you have an aneurysm. But for the most part you'll know is a different type of pain and usually comes along with abdominal pain for an abdominal aneurysm. So it's sort of a constellation of things that definitely is distinctively different from your everyday back pain.
Host: Okay, so there are warning signs, which is good to know and that we should all pay attention to. So then what typically happens when a patient has an aortic aneurysm?
Dr. Vasquez: Well, honestly, very typically they're not symptomatic. Patients don't know they have an aneurysm. I would say for the most part, our patients that come and see us for aneurysms, these things were found incidentally from a CAT scan. The most common scenario is a patient went to the emergency room for some other ailment, underwent some kind of imaging, most likely a CT scan. And lo and behold, there's an aneurysm. And then they get referred to us for workup. So it's really mostly a problem that doesn't have symptoms and is usually found just incidentally when someone goes and visits their primary care doctor or has an emergency room visit where they did a CT scan. Once the patient has symptoms, however, it's a little bit more urgent. And then that changes sort of the algorithm of how we treat them.
Host: So you just mentioned referred to you. Can we talk about the aortic center for a minute? Can you tell us about it and what specialists are involved?
Dr. Vasquez: We realize that aortic disease and the treatment of aortic patients is very complex. Like I said earlier, it is the main artery in our body. So it's a very complex process that requires a multidisciplinary approach for the best outcomes. Here at the Aortic Center, we have a cardiothoracic team and a vascular surgery team, as well as a cardiology team that sees the patient assesses the whole patient, their cardiac function. Do we have to fix the aneurysm, how we're going to fix the aneurysm, what's the best approach? And so we feel that this multidisciplinary approach provides a better consensus and a better plan that leads, we hope to a better outcome for the patient.
Host: So let's talk a little bit more about that approach. So then, what are the typical steps once a patient consults with you?
Dr. Vasquez: So the patient will come into the aortic center, they'll get checked in. They'll be placed into an exam room. Myself or another vascular surgeon along with our cardiothoracic surgeons will examine the patient, review the films with the patient, go over with them. It's very important to go through the images with the patients, show them where the aneurysm is. It kind of helps, you know, they say a picture's worth a thousand words and that really is true because it's really good to go through the imaging with them because they get, they are able to grasp the idea of what this is and how we're going to fix it. Once we examine the patient and go through the images, then we'll sort of sit down as a team and decide, okay, what is the best next step for this patient? How are we going to approach it? How are we going to fix it? And there's multiple different ways we can do it. And so once we become, once we have that consensus between all of us, then the patient isn't scheduled for the procedure if necessary. A lot of times they don't need a procedure and they come in and they've been diagnosed with the aneurysm, but it doesn't need treatment right now. And then they get into a surveillance program with the Aortic Center.
Host: So let's talk about that treatment. What is treatment for an aortic aneurysm?
Dr. Vasquez: Well, there's two basic ways to treat the aneurysm. One is with an endovascular approach. What does that mean? That means that we are inserting a stent within the aorta. That excludes the blood flow from entering the aneurysm. The biggest risk for an aneurysm is that it ruptures. That's the reason why patients could die from an aneurysm. A stent graph goes inside the aorta and now diverts the blood away from the aneurysm, allowing it to shrink away and not become an issue. The second way we treat aneurysms is with open surgery. There are certain anatomic restrictions that this particular aneurysm may not be able to get a stent and then we have to perform open surgery to replace the aorta.
Host: So are there ways to lower risk factors associated with aortic aneurysms?
Dr. Vasquez: You know, there's a lot of things we can do in terms of lifestyle and you know, we all know what they are, but definitely a healthy eating habits and controlling your blood pressure are paramount. The most important thing, however, is to not become a smoker. And if you are a smoker to stop, we know there is a direct correlation between smoking and aneurysm formation and aneurysm rupture. So I would say the best thing to do would be control your blood pressure. Become a nonsmoker or stay a nonsmoker is your best chance of never having to deal with this.
Host: That is great advice. You know we always hear no your numbers. We should all know our numbers. Well, you should certainly know your cholesterol numbers and your blood pressure numbers. Those are really two important numbers to know when it comes to aortic aneurysm.
Dr. Vasquez: Absolutely, and you know the blood pressure makes sense. If it's the main artery in your body, it is basically under the pressure of your constant blood pressure, every beat of your heart and so it makes sense that the higher your blood pressure, the more pressure on the wall of the aorta, which then leads to this dilation and aneurysm formation. The important thing I want to emphasize on blood pressure is you don't feel high blood pressure for a very long time so it's very important to check with your primary care physician, know your number though, whether or not you need to be treated and what's the best treatment you can start to get that blood pressure within normal range.
Host: Really, really important things to remember and try to put into place and for someone listening. If you're looking for a hospital and or specialist, the Aortic Center at Baylor Scott and White Heart and Vascular Hospital Dallas can be reached by calling 214-820-4876, 214-820-4876. You can also send an email to dallasaorticcenteratbswhealth.org. And that information will be in the transcript for this podcast, Dr. Vasquez, this has really been interesting and informative. Thank you for your time.
Dr. Vasquez: Thank you. I appreciate you having me.
Host: That's Dr. Jay Vasquez, Medical Director for Surgical Services and Vascular Surgeon on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas and Baylor University Medical Center. And thanks for checking out this episode of Heart Speak, to find a specialist on the medical staff once again call (214) 820-4876 you can also visit BaylorHeartHospital.com/aorticcenter. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for listening. Baylor Scott and White Heart and Vascular Hospital Dallas and Fort Worth joint ownership with physicians.