Preventing Abdominal Aortic Aneurysm with Life-Saving Procedure
Dr. Sara Honari explains what an endovascular aortic aneurysm is and how to repair it.
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Learn more about our physicians at www.dignityhealth.org/ourdoctors.
Sara Honari, MD
Sara Honari completed her undergraduate education at the University of Southern California. She then graduated with high honors from the Ross University School of Medicine. Her education continued at Conemaugh Memorial Medical Center, where she was awarded Best Intern of the Year during her General Surgery internship. After completing her general surgery residency, she continued on to her vascular surgery fellowship program at Maimonides Medical Center in Brooklyn, NY. Upon completion, Dr. Honari made the decision to relocate to Bakersfield, CA and joined the team at Kern Vascular Center, helping to meet the needs of our local community. In her free time, Dr. Honari enjoys travelling and spending time with friends and family.Learn more about our physicians at www.dignityhealth.org/ourdoctors.
Transcription:
Preventing Abdominal Aortic Aneurysm with Life-Saving Procedure
Bill Klaproth (Host): An abdominal aortic aneurysm is no laughing matter. Like a balloon blown up too much, an aneurysm could rupture or pop which is a potentially fatal situation. However, there is a procedure used to treat these types of aneurysms called an endovascular aneurysm repair. Here to help us understand more about this repair, is Dr. Sara Honari, a Vascular Surgeon with Dignity Health. Dr. Honari, thanks for your time.
Sara Honari, MD (Guest): Thank you for having me Bill.
Host: You bet. So, Dr. Honari, how are most aneurysms discovered? Isn’t it after they rupture?
Dr. Honari: Thankfully and more recently, that’s not how they are discovered. In the past, that is how they were eventually discovered, and the mortality was over 80%. However, with the fact that we know what the risk factors for abdominal aortic aneurysms are now; we have screening programs and we know who to check for aneurysms. So, with just a simple ultrasound of the belly, you can figure out if a patient has an aneurysm and then you can follow them and make sure that when they get to the point that they are at risk for rupture; they are repaired prior to rupture.
Host: So, when you say we know who to check for an aneurysm, who is that person? Who is at risk for this? How do you know that?
Dr. Honari: People who are at risk for the aorta ballooning or enlarging are mainly smokers, males, people who have high blood pressure, genetics play a role as well. So, if you have a family history, it’s also very important to be screened.
Host: All right. Very good. So, let’s dig into this endovascular aneurysm repair or EVAR as it’s known. What can you tell us about this procedure?
Dr. Honari: So, EVAR is endovascular aortic repair or abdominal aortic repair. When an aorta, which is the largest blood vessel in our body enlarges or balloons up, it’s called an aneurysm. And with an endovascular aortic repair or EVAR; it’s a minimally invasive surgery to actually repair the aorta. Normally, the aorta is less than three centimeters however, when the aorta enlarges or balloons up to five centimeters or more; the risk of rupture and death becomes exceedingly higher.
Host: All right. So, you mentioned minimally invasive then so, the difference between an endovascular and an open procedure it sounds like with an open procedure it would be major surgery and then with the endovascular procedure; it’s minimally invasive. Is that right or what else can you tell us about the difference between the two?
Dr. Honari: Yes. The difference between an open repair and an endovascular repair is the invasiveness of the procedure. An open repair requires a very large incision, pretty much from your sternum all the way down past your belly button and the incision requires over a week of hospital stay. It’s a longer procedure. Whereas an endovascular repair can be done through two small incisions in the groin and usually just a one night stay in the hospital.
Host: That is amazing. So, I would imagine someone has to have specialized training for this. Who can perform this procedure?
Dr. Honari: So, procedures on all blood vessels in the body other than the ones in the heart and the brain are performed by vascular surgeons. It requires extensive training to become board-certified vascular surgeons and these are the surgeons that can and perform the surgeries on these blood vessels.
Host: So, who is a good candidate then for the EVAR procedure?
Dr. Honari: A person who is a good candidate is someone whose aorta has ballooned up to greater than five centimeters. Once the aorta is greater than four centimeters; it’s very important for them to be closely monitored by a vascular surgeon because there are certain characteristics of the type of ballooning that would require intervention even sooner. However, once it reaches five centimeters or larger, the risk of death from the rupture outweighs the risk of undergoing surgery.
Host: And then how do you determine who is a good candidate for minimally invasive and then who would still need an open procedure?
Dr. Honari: So, candidates for minimally invasive again depend on the characteristics of the aorta. The aneurysmal portion is usually just below the blood vessels that feed our kidneys called the renal arteries. If there’s enough normal aorta below the renal arteries, we need at least 1.5 centimeters, 15 millimeters in order to repair it endovascularly. So, if the patient has these characteristics, they can undergo just a straightforward endovascular aortic repair. However, if they do not have these characteristics, we actually have advances in the stent grafts we use, and we can manufacture a stent graft specifically for that patient’s anatomy. By using a CT scan and 3D modeling, we build a graft and actually use it in patients. So, anyone with an abdominal aortic aneurysm usually undergoes an endovascular aortic repair.
Host: Got you. Very interesting. So, on a comparison basis, what do you do more of, the endovascular repair or the open repair?
Dr. Honari: We do more endovascular repairs now which has caused a great increase in the number of patients that we can actually treat because an open repair like I had mentioned earlier still requires extensive general anesthesia and longer stays, therefore patients who have more comorbidities or heart issues and lung issues don’t do too well from an aneurysm repair that requires a large incision and a long stay in the hospital. So, thankfully, with these advancements in technology; we have been able to actually treat more patients and more recently we are doing more of the endovascular repair than open repair.
Host: Got you. So, as far as the aneurysm itself goes, are all aneurysms suitable for the endovascular aneurysm repair?
Dr. Honari: Yes as long as they are not involving the blood vessels that feed the kidneys or the intestines, they are suitable.
Host: Hence, probably why you are doing more of the endovascular repair procedures then, is that right?
Dr. Honari: Yes.
Host: All right Dr. Honari, is there anything else we should know about an aortic aneurysm and the EVAR procedure?
Dr. Honari: What we should know about aortic aneurysms is that people who smoke are at risk. In addition, if you have a genetic factor, if you had a mother, father, uncle or aunt who had an aortic aneurysm; it’s important to see a vascular surgeon and to actually get an ultrasound and see if you are at risk. That way, we avoid the rupture. So, if we know about it well before it reaches the point of rupture; it can be repaired, and any kind of surgery is nerve wracking and it’s important to know that an endovascular aortic repair now with the technology we have; is just a one night stay in the hospital and it’s more important to be able to know which patients are at risk. So, if anybody does feel as though they are at risk, they should have an aortic ultrasound in order to evaluate the size of their aorta.
Host: It’s really interesting. So, if someone is concerned about this should they ask their physician about the screening and ask for the screening?
Dr. Honari: Yes, they definitely should.
Host: And it’s a matter of going through an ultrasound then, is that how you find this?
Dr. Honari: Yes, it’s just about a 20 minute ultrasound of the abdomen. It doesn’t hurt. It’s just like the ultrasound they would do if the female is pregnant how you just put a probe on your stomach and then we are able to measure the aorta in that way.
Host: And I’m sure that gives people peace of mind then knowing. It’s any easy way to find out.
Dr. Honari: Yes, definitely.
Host: Dr. Honari, thank you so much for your time today. It’s been a pleasure talking with you. We appreciate it. For more information about this aneurysm repair, please visit www.dignityhealth.org/bakersfield, that’s www.dignityhealth.org/bakerfield. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.
Preventing Abdominal Aortic Aneurysm with Life-Saving Procedure
Bill Klaproth (Host): An abdominal aortic aneurysm is no laughing matter. Like a balloon blown up too much, an aneurysm could rupture or pop which is a potentially fatal situation. However, there is a procedure used to treat these types of aneurysms called an endovascular aneurysm repair. Here to help us understand more about this repair, is Dr. Sara Honari, a Vascular Surgeon with Dignity Health. Dr. Honari, thanks for your time.
Sara Honari, MD (Guest): Thank you for having me Bill.
Host: You bet. So, Dr. Honari, how are most aneurysms discovered? Isn’t it after they rupture?
Dr. Honari: Thankfully and more recently, that’s not how they are discovered. In the past, that is how they were eventually discovered, and the mortality was over 80%. However, with the fact that we know what the risk factors for abdominal aortic aneurysms are now; we have screening programs and we know who to check for aneurysms. So, with just a simple ultrasound of the belly, you can figure out if a patient has an aneurysm and then you can follow them and make sure that when they get to the point that they are at risk for rupture; they are repaired prior to rupture.
Host: So, when you say we know who to check for an aneurysm, who is that person? Who is at risk for this? How do you know that?
Dr. Honari: People who are at risk for the aorta ballooning or enlarging are mainly smokers, males, people who have high blood pressure, genetics play a role as well. So, if you have a family history, it’s also very important to be screened.
Host: All right. Very good. So, let’s dig into this endovascular aneurysm repair or EVAR as it’s known. What can you tell us about this procedure?
Dr. Honari: So, EVAR is endovascular aortic repair or abdominal aortic repair. When an aorta, which is the largest blood vessel in our body enlarges or balloons up, it’s called an aneurysm. And with an endovascular aortic repair or EVAR; it’s a minimally invasive surgery to actually repair the aorta. Normally, the aorta is less than three centimeters however, when the aorta enlarges or balloons up to five centimeters or more; the risk of rupture and death becomes exceedingly higher.
Host: All right. So, you mentioned minimally invasive then so, the difference between an endovascular and an open procedure it sounds like with an open procedure it would be major surgery and then with the endovascular procedure; it’s minimally invasive. Is that right or what else can you tell us about the difference between the two?
Dr. Honari: Yes. The difference between an open repair and an endovascular repair is the invasiveness of the procedure. An open repair requires a very large incision, pretty much from your sternum all the way down past your belly button and the incision requires over a week of hospital stay. It’s a longer procedure. Whereas an endovascular repair can be done through two small incisions in the groin and usually just a one night stay in the hospital.
Host: That is amazing. So, I would imagine someone has to have specialized training for this. Who can perform this procedure?
Dr. Honari: So, procedures on all blood vessels in the body other than the ones in the heart and the brain are performed by vascular surgeons. It requires extensive training to become board-certified vascular surgeons and these are the surgeons that can and perform the surgeries on these blood vessels.
Host: So, who is a good candidate then for the EVAR procedure?
Dr. Honari: A person who is a good candidate is someone whose aorta has ballooned up to greater than five centimeters. Once the aorta is greater than four centimeters; it’s very important for them to be closely monitored by a vascular surgeon because there are certain characteristics of the type of ballooning that would require intervention even sooner. However, once it reaches five centimeters or larger, the risk of death from the rupture outweighs the risk of undergoing surgery.
Host: And then how do you determine who is a good candidate for minimally invasive and then who would still need an open procedure?
Dr. Honari: So, candidates for minimally invasive again depend on the characteristics of the aorta. The aneurysmal portion is usually just below the blood vessels that feed our kidneys called the renal arteries. If there’s enough normal aorta below the renal arteries, we need at least 1.5 centimeters, 15 millimeters in order to repair it endovascularly. So, if the patient has these characteristics, they can undergo just a straightforward endovascular aortic repair. However, if they do not have these characteristics, we actually have advances in the stent grafts we use, and we can manufacture a stent graft specifically for that patient’s anatomy. By using a CT scan and 3D modeling, we build a graft and actually use it in patients. So, anyone with an abdominal aortic aneurysm usually undergoes an endovascular aortic repair.
Host: Got you. Very interesting. So, on a comparison basis, what do you do more of, the endovascular repair or the open repair?
Dr. Honari: We do more endovascular repairs now which has caused a great increase in the number of patients that we can actually treat because an open repair like I had mentioned earlier still requires extensive general anesthesia and longer stays, therefore patients who have more comorbidities or heart issues and lung issues don’t do too well from an aneurysm repair that requires a large incision and a long stay in the hospital. So, thankfully, with these advancements in technology; we have been able to actually treat more patients and more recently we are doing more of the endovascular repair than open repair.
Host: Got you. So, as far as the aneurysm itself goes, are all aneurysms suitable for the endovascular aneurysm repair?
Dr. Honari: Yes as long as they are not involving the blood vessels that feed the kidneys or the intestines, they are suitable.
Host: Hence, probably why you are doing more of the endovascular repair procedures then, is that right?
Dr. Honari: Yes.
Host: All right Dr. Honari, is there anything else we should know about an aortic aneurysm and the EVAR procedure?
Dr. Honari: What we should know about aortic aneurysms is that people who smoke are at risk. In addition, if you have a genetic factor, if you had a mother, father, uncle or aunt who had an aortic aneurysm; it’s important to see a vascular surgeon and to actually get an ultrasound and see if you are at risk. That way, we avoid the rupture. So, if we know about it well before it reaches the point of rupture; it can be repaired, and any kind of surgery is nerve wracking and it’s important to know that an endovascular aortic repair now with the technology we have; is just a one night stay in the hospital and it’s more important to be able to know which patients are at risk. So, if anybody does feel as though they are at risk, they should have an aortic ultrasound in order to evaluate the size of their aorta.
Host: It’s really interesting. So, if someone is concerned about this should they ask their physician about the screening and ask for the screening?
Dr. Honari: Yes, they definitely should.
Host: And it’s a matter of going through an ultrasound then, is that how you find this?
Dr. Honari: Yes, it’s just about a 20 minute ultrasound of the abdomen. It doesn’t hurt. It’s just like the ultrasound they would do if the female is pregnant how you just put a probe on your stomach and then we are able to measure the aorta in that way.
Host: And I’m sure that gives people peace of mind then knowing. It’s any easy way to find out.
Dr. Honari: Yes, definitely.
Host: Dr. Honari, thank you so much for your time today. It’s been a pleasure talking with you. We appreciate it. For more information about this aneurysm repair, please visit www.dignityhealth.org/bakersfield, that’s www.dignityhealth.org/bakerfield. This is Hello Healthy, a Dignity Health podcast. I’m Bill Klaproth. Thanks for listening.