Prakash Chandran (Host): Imagine your body's vascular system as a complex network of highways consisting of veins and arteries that tirelessly transport blood to support every organ. At the heart of this intricate system lies the aorta, the main artery that carries blood from your heart to the rest of your body. However, this vital blood vessel is not immune to disease and damage, which is why screening plays a crucial role in safeguarding your vascular health. In particular, abdominal aortic aneurysm or AAA screening can detect warning signs early and allow time for potentially life-saving treatment. We're going to talk about it today with Dr. Laura Boitano, a vascular surgeon, and Lisa Arello, a nurse practitioner, both with Harrington Hospital.

Host: This is Healthy Takeout, a podcast from Harrington Hospital. My name is Prakash Chandran. So, Lisa and Dr. Boitano, thank you so much for joining us today. I really appreciate your time. Dr. Boitano, I thought I would start with you and just cover the basics. What exactly is an abdominal aortic aneurysm?

Dr. Laura Boitano: Sure. So, thank you so much for having us on this podcast. So, an abdominal aortic aneurysm is a ballooning or outpouching of the abdominal aorta. And usually, we think of the abdominal aortic aneurysm is starting at about three centimeters in size. And it can get much, much larger. There are certain risk factors that we look for in patients who may be at risk for developing abdominal aortic aneurysms. And the major ones are history of smoking, an older age, being male, and also family history of having an abdominal aortic aneurysm in a first-degree relative.

Host: And Dr. Boitano, I am curious what exactly happens when the aneurysm ruptures?

Dr. Laura Boitano: So, an aneurysm rupture is a life-threatening emergency. Patients often experience severe abdominal and back pain. It's not subtle. Unfortunately, many patients die before they go to the hospital. But if they do make it to the hospital, we provide emergency lifesaving treatments with repair of this aneurysm. So, it's really important that patients who are at highest risk for abdominal aortic aneurysms are screened and remained in surveillance to try to avoid the risk of rupture because it's such a life-threatening emergency.

Host: Yeah, absolutely. And I know you touched on this already, Dr. Boitano, but you know, Lisa, I'd love for you to go maybe into a little bit more detail around who's at most risk or the highest risk for getting an abdominal aortic aneurysm.

Lisa Arello: Yes, absolutely. Being male gender is an easy one, and anyone who is aged 65 or older. On top of that, risk factors such as uncontrolled high blood pressure, continued tobacco use. And those that have a genetic predisposition are other people that we would try to screen and ensure they did not have an aneurysm.

Host: So Lisa, you know, Dr. Boitano talked about how fast things can happen when there is an aneurysm rupture, and that is why there is this importance for screening. Can you talk to us a little bit about what the screening process is like?

Lisa Arello: Yes. So, the screening process is non-invasive and not painful, which is the greatest part of it. They come into our vascular lab here in the clinic, and an ultrasound done that focuses on evaluating the aorta and its entirety to determine its size and any other abnormal characteristics that we would worry about, so that the doctor can see not only the size of it, but also the images to what the quality of their aortic aneurysm is. We would then, based upon that size and characteristic, determine what would be the next appropriate timeframe for a patient to come in and have that ultrasound repeated.

Host: And Dr. Boitano, who exactly should be thinking about getting screened? Now, you obviously mentioned when there's a history of smoking, family history, 65 and older, and even if you're a male, but is this something that people usually come in at age 50 to do? What's the recommendation there?

Dr. Laura Boitano: Sure. There are a number of societies that have recommendations regarding screening and the US Preventative Task Force also has recommendations. Ultimately, taking all of that together, we recommend that men and women age 65 and older or 65 to 75, I should say, who have either a history of smoking or a family history of aneurysm disease, are screened. Screening women is a little more controversial and not accepted by all societies. But since women are at risk, even though they're at less risk than men and the test is minimally invasive, it doesn't hurt, we do recommend screening in women and that is supported by the Society for Vascular Surgery, which is the society that we utilized for a lot of our screening recommendations.

Host: And Dr. Boitano, why is that? Why is it not accepted in society for a woman to get screened?

Dr. Laura Boitano: The risk of the abdominal aortic aneurysm is much higher in men than women. And so if you look at the population level, the benefit to screening is much greater in men. However, because a ruptured abdominal aortic aneurysm is such a life-threatening emergency, we believe that there still remains a benefit for women, and we do recommend continued screening for women.

Host: Understood. So Lisa, if an aneurysm is found during screening, what are the patient's next steps?

Lisa Arello: After they have the ultrasound in clinic, we also perform an exam. We feel the abdomen and listen for any other signs and ask them a series of questions to ensure that we're considering all aspects of relevancy to the patient. Based upon the size of the ultrasound demonstrated the aneurysm, we would then recommend an interval. In some cases ,as much as a year; some cases, three years. And when the aneurysm is larger, the patient then becomes treated with a CAT scan as it is more anatomy-specific than the duplex.

Host: And Lisa, if an aneurysm is not found, but you still have the risk factors there, after you get screened and nothing is found, is there a particular interval or cadence that you recommend that people still continually get checked?

Lisa Arello: We recommend at that point yearly kind of physical exams; look, listen and feel the abdomen. But at this time, the recommendation is not to continue routine screening if it's been demonstrated that there was no aneurysm.

Dr. Laura Boitano: The only thing I'll add is that sometimes we see on the ultrasound reports that a patient has ectasia of their aorta, which is a small dilation of their abdominal aorta that doesn't quite meet criteria for aneurysm. It's sort of pre-aneurysmal, and that's when the aorta is 2.5 to 2.9 centimeter. And in those patients, we do recommend a followup ultrasound, but that's in 10 years. So, the interval is very, very wide for their screenings repeated.

Host: Okay. That's helpful to know, Dr. Boitano. I wanted to also ask the types of treatments that are available for patients. Can you share a little bit more about those?

Dr. Laura Boitano: Sure. So, we have two major types of treatments for abdominal aortic aneurysm. The first is the conventional open surgery. It's a major abdominal operation where we make an incision in the abdomen and we actually sew in a tube graft where the aorta is. And so, blood then flows into this plastic tube graft. And then, we exclude the aneurysm. And most patients who get this procedure are younger and healthier because it is a major operation and does require a hospital stay and an ICU stay.

The second major type of treatment is a minimally invasive endovascular treatment where we place a stent graft into the aorta so that blood flows through the stent graft rather than through the aneurysm. And this is a minimally invasive procedure where we make a centimeter incision in the groin to use wires and catheters to place the stent. And most patients only need a one night stay in the hospital after this type of operation. But it's really important to mention that especially after the minimally invasive operation, patients need continued surveillance of the aorta because there's a risk that they could develop certain complications long-term after the procedure that we can easily monitor in the clinic and catch before it too becomes a problem.

Host: So Lisa, just before we start to close, you know, someone might be listening to this and might be thinking, "Look, there's so much stuff I have to get screened for as I get older." But you know, you've probably worked with lots of different patients around screening and making sure to be proactive about their health. If there's one thing that you know to be true that you would like to share or leave with the audience, what might that be?

Lisa Arello: Yes. For people that have smoking history or family history, they also undergo other CAT scan screenings such as the lungs. We often can combine the studies and do them together so that they're having one appointment and one imaging. The other is that we try really hard to make this as convenient as possible. We have flexibility in scheduling and meeting the needs of the patients to come in for it. The benefit is so great because a real aneurysm that becomes large is just so detrimental and the risk is high. I would encourage everybody to consider this as part of their preventive care.

Host: And Dr. Boitano, is there anything worth adding or just anything else that our audience should know?

Dr. Laura Boitano: Sure. The only thing that I would add is that most patients who get screened have small aneurysms and the risk of rupture of a small aneurysm is exceedingly low. And we don't recommend any lifestyle changes when this is identified. So, I don't want to scare people into thinking that they have this ticking time bomb in their abdomen. But it is really important to identify these early to prevent the dreaded complication of rupture later on. But at the small sizes, the risk of rupture is exceedingly low. And Lisa and I take a lot of pride in taking care of these patients in our Charlton office and have a lot of availability for both screenings and followup appointments.

Host: Yeah, that's wonderful. So Lisa, where can patients go to learn more and get in touch?

Lisa Arello: They can go to the Harrington website, but they're also welcome to give our office a call and we'll provide additional material at 508-248-8105. We're located at the 10 North Main Street site. And we do have written literature for anybody that's interested.

Host: Well, Dr. Boitano and Lisa, thank you so much for your time today. This has been truly informative.

Dr. Laura Boitano: Thank you so much for having us.

Lisa Arello: Thank you. It's been a pleasure.

Prakash Chandran (Host): That was Dr. Laura Boitano, a vascular surgeon, and Lisa Arello, a nurse practitioner, both with Harrington Hospital. For more information, you can head to harringtonhospital.org or call 508-248-8105 to schedule your screening ultrasound. If you found this podcast to be 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 checking out this episode of Healthy Takeout. My name is Prakash Chandran. And until next time, be well.