Scott Webb (Host): If you have a close family member
who's had a heart attack or heart disease, you probably know that your chance
of having the same, is high. But there's another condition that has many of the
same risk factors of heart disease, including family history. Abdominal aortic
aneurysm, also known as AAA, is caused by a weakness in the body's largest
artery, which runs from the heart to the lower abdomen. When pressure from the
body's circulation hits that weakened area, the artery stretches and balloons.
Without timely intervention, this aneurysm can rupture. And when that happens,
it usually leads to death or long-term disability. But when caught early and
monitored by a physician, a AAA can be repaired. Dr. Michael Tuchek, a Cardiac
and Vascular Surgeon working in Crownpoint, will talk to us today about
abdominal aortic aneurysms and how treatment options can save lives.

 This is the Franciscan
Health Doc Pod. I'm Scott Webb. Doctor, great to speak with you today. We're
going to talk about AAA and not the car folks, of course, we're going to talk
about abdominal aortic aneurysm. So AAA, I think we'll tend to abbreviate that
here today. So let's start there. What is AAA and why do we need to worry about
them?

Michael Tuchek, DO, FACS: So AAA as you said, it stands
for abdominal aortic aneurysms. Aneurysms are like balloons in an artery. If you
put too much hair in a balloon, it pops, it ruptures, and when it does, if
that's in an artery, that rupture leads to massive internal bleeding. It's like
putting a pin in a balloon. It pops and you die about 80 to 90% of the time
when that happens.

Well, the same is true with aneurysms when they pop, and so you
want to get to it before that happens, obviously. So most people have heard of
brain aneurysms except when they burst, it bleeds causing a stroke, and you'll
frequently have headaches and symptoms before that happens. The problem with
AAAs is you don't have any symptoms Almost all the time, it's symptom free
until it ruptures and then it's too late. That's why AAAs are known as ticking
time bombs. I'm not sure I like that term, but you just don't know it until it
ruptures. Usually when I see patients with aneurysms, they've had them for 5,
10, 15 years.

They've been silently growing year after year until one day the
wall gets so thinned out, it bursts. God forbid that should happen, but a
patient would get sudden abdominal, flank and back pain, usually on the left
side, which is severe. Sometimes they get nauseous or sweaty or pass out, short
of breath, but most of the time, AAA causes no symptoms until it bursts. That's
why it's a tricky one.

Host: Yeah, tricky for sure. So if there aren't really
any symptoms, then what are the risk factors?

Michael Tuchek, DO, FACS: So the risk factors
ironically, are just like stroke and heart attack. Smoking causes a lot of
issues, heart disease, emphysema, lung cancer. But of course it also causes
AAAs. That's one of those main risk factors. Men more often than women get
AAAs. So men have to look out for it more than women. High blood pressure.
Obvious, right? If you have high blood pressure pounding away at the weakened
wall of an artery, 24/7, 365, that puts you at risk, being elderly or obese can
increase your risks. But 20% of the time there is a family history, the
atherosclerosis we talked about and arterial sclerosis make the wall hard and
that weakens it, and that's what increases your risk of AAA ultimately.

Host: All right. So you said more often than not it's
men, but it could be men and women and let's just say that they have the risk
factors, right? So someone comes in and they say, I have all the risk factors
for AAA, stroke, and heart attack, but in particular with AAA, how do you
detect them?

Michael Tuchek, DO, FACS: Well, the thing is, we got to
remember that they're really common. It's the 12th leading cause of death in
the United States, so it's not something you want to ignore it, it's affected a
lot of people you know, you and I know, for example, Lucille Ball and George C.
Scott who played Patton, both died of a ruptured and even Einstein, died of a
ruptured aneurysm. Gordon Lightfoot, who is, you know, pop star,

Gordon

Host: Yeah, it just passed.

Michael Tuchek, DO, FACS: Yeah he just died. He had a
ruptured aneurysm while he was on tour about 20 years ago. He was in a coma, I
think for four months. He was never the same because he had to go through a
ruptured AAA and people like Rodney Dangerfield had their AAA operated on. So
it's a fairly common thing. People just don't realize how common it is. The
good news is we can easily detect them again with some real simple,
non-invasive ultrasounds like they used to check the baby in pregnant women,
they send sound waves in. And in a few minutes, you know whether or not you've
got an aneurysm.

If they detect one, we usually order that gold standard CAT
scan so we can look at the size and the shape. An MRI can show it, but really
CAT scan's the best way for us to detect them currently.

Host: Yeah. And how big do they need to get before you
do something, right? So let's just say someone has the risk factors. You do the
gold standard CAT scan and you say, yep, you have a AAA. Is it something where
there's some surveillance involved if it's relatively small, or is it always
let's get them into the OR?

Michael Tuchek, DO, FACS: Right. So depends, right? So
we look at the CAT scan and we look at a couple of different things. Most
importantly, as you've always heard, size does matter. The bigger the AAA, the
thinner the walls are. The weaker the walls are, the higher the risk of
rupture. So like a balloon after 30 puffs of air, it gets big, the wall gets
thin, then it pops.

The same is true for AAA, and we know that when it gets to be
about five to five and a half centimeters, that's about two and a half inches
in diameter. The wall's starting to thin out and the risk of rupture starts to
go up, and that risk of rupture is about five to 10% per year. The problem is I
can't predict who the lucky 90 to 95% are and who the unlucky five to 10% are.

So if you otherwise are healthy and your risk factors are low,
we usually sit down with our patients and talk to them about the treatment
options. The other thing we look at on the CAT scan is the shape, not just the
size, but the shape. Some have weird shapes. They're sacular like a bald spot
in an old tire.

You and I are old enough to remember inner tubes, right? The
bald spot, you can't predict. Or some of them grow rapidly, some of them grow
slowly, so they're a little bit more unpredictable. And those kinds of
aneurysms, we might treat at a smaller size, smaller than five centimeters.
They're rare. They're probably two to 5% of the time, but they're still out
there.

But if they're bigger than five centimeters, you really have
three options to talk to your doctor about. First you could do nothing. Now,
that's not the best choice of the three, but some people are sick, they're old,
they're frail, and they take the 90 to 95% chance they won't rupture this year
and move on.

But for most people, like you and I, there's really two good
options. There's the standard open AAA surgery. It's tried and true way of
fixing aneurysms. You remove the aneurysm, you replace it with a Dacron graft.
It works every single time. It's one and done. You never have to worry about it
again. But it's a big operation and you have to have good anatomy or bad
anatomy depending on what it is. But that operation works very well. The other
much more popular option these days is to use minimally invasive, what we call
endovascular stent grafting. We make two small access sites in the groin and we
insert a metal stent, like chicken wire that expands and it's lined with a
graft. And we build the graft inside the AAA.

Kind of looks like a pair of pants on the inside, starting at
the kidney arteries, kind of behind your breast bone down low. And we extend it
down towards the groins on both sides. So that's why it looks like a pair of
pants. And we do all this while the blood's still flowing. This works about 96%
of the time.

 You have to get yearly
CAT scans to make sure all is well afterwards, but you go home the next day.
You're not there for a week, just the next day, and you recover a lot faster in
just a few weeks instead of a few months that it takes to recover from the big
surgery. So that's the most popular option currently.

Host: Absolutely. Wondering, you know, we can maybe
leave insurance out of it, but just generally from your perspective, do you
wish that everybody would get screened for AAA?

Michael Tuchek, DO, FACS: Well, not everyone, but I
think anybody who's at higher risk, otherwise we'd never get done screening
people.

Host: Yeah. It's all be doing right.

Michael Tuchek, DO, FACS: Exactly. Yeah. But I think
people that are higher risk, like I mentioned before, older people, people with
emphysema, smokers, high blood pressure, family history, all those kinds of
patients should be screened. no doctor visit involved. You just sign in and get
your screening done. If you qualify. There is a free AAA screening ultrasound
under, I think it's called, Welcome to Medicare.

Your first visit when you turn 64, that's free through the Save
Act. Everyone should take advantage of that. Keep in mind, just to put it in
perspective, again, there's about 200,000 AAAs diagnosed every year. The
problem is that's because people screened or they accidentally found it when
they got their gallbladder ultrasound, when they had stomach pain, but most of
the time they're dying, rupturing before they're ever found. So the number of
people that could be saved is tremendous, but you've got to get screened first.

Host: Yeah. You made reference to COVID earlier and it's
like, well, you know how many people had COVID but didn't know it. And the same
thing here with AAA as you say, you know about those cases, the 200,000 because
those people got screened, but how many people aren't being screened even
though they have the risk factors? Right.

Michael Tuchek, DO, FACS: Right. That's absolutely true.

Host: Well, doctor, it's always a pleasure to have you
on. It's my pleasure to have experts on, to learn from them, to talk through
some of this stuff. I'm sure listeners appreciate this. I know that at least
one person whose life you saved because she heard one of our podcasts, so keep
coming on, keep being awesome and thanks so much.

Michael Tuchek, DO, FACS: I appreciate it, Scott. Thank
you.

Scott Webb (Host): And as a reminder to our listeners,
Franciscan Health offers low cost non-invasive screenings for heart, lung, and
vascular health, including aaa. And for more details, go to franciscan
health.org/screening bundles.

Host: And if you found this podcast helpful, please
share it on your social channels. And be sure to check out the full podcast
library for additional topics of interest. This is the Franciscan Health Doc
Pod. I'm Scott Webb. Stay well, and we'll talk again next time.