Scott Webb (Host): Abdominal aortic aneurysms or triple As fall under the category of silent killers in Medicine. They're more common than you might think. They're also highly treatable when found and diagnosed early. Joining me today to talk more about triple As is vascular surgeon, Dr. Elizabeth Blazick.

Welcome to Answers in Vascular with the Vascular Care Group. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to talk about abdominal aortic aneurysms, which is not easy to say, which is why we'll probably abbreviate and say triple A today. So, let's start there, what is triple A and how does it develop?

Dr. Elizabeth Blazick: A triple A is an aneurysm that develops in the abdominal section of the aorta. So, a lot like you said, it's a lot of A words right there. So, just to kind of break it down, the aorta is the largest artery in your body. And it runs directly from your heart in the chest. It makes a U-turn in the upper of the chest where it gives off the blood vessels to the arms, into the head and then it goes down through the chest into the abdomen, where in the abdomen, it gives off the blood vessels to your internal organs. And then, right around the level of your belly button, it splits into two branches and goes down and feeds the pelvis and the legs. So when we're talking about an abdominal aortic aneurysm, we're talking about that segment at the abdomen, usually right before it splits into those two vessels that go down into the pelvis. And what an aneurysm is, is a weakening and bulging of the wall of any blood vessel. So based on that, an abdominal aortic aneurysm is a weakening or a bulging in the abdominal section of your aorta.

Host : Yeah. When we think about how it develops or how common is this, you know, I've hosted a few of these on triple A, but is it terribly common and how does one develop a triple A?

Dr. Elizabeth Blazick: It is very common actually. I think it's probably more common than most people think and it's probably a little hard to know exactly how common it is. But the statistics that we have now say that nearly about 200,000 people in the United states are diagnosed with triple A annually. And it's considered the fifteenth overall cause of death in Americans. And it's the 10th biggest killer for men 55 years and older. So, it is pretty common. And for that reason, we do really want to take it seriously because where we're going to make the difference in people who have diagnosis of triple A is trying to diagnose it and to effectively treat it before it gets to the point of rupture.

Host : Yeah. And you say, men 55 and older. I happen to be 56, so it's always a problem for me when I host these. I'm like, "Wait a minute. I'm right in that target range." What are some of the risk factors though that increase someone's likelihood of developing a triple A?

Dr. Elizabeth Blazick: Age is probably the biggest risk factor. The risk of developing one increases sharply after the age of 50, but peaks like in the 70s, the late decade of life. Men are far more likely than women to developing a triple A. They're at least twice as likely to develop a triple A. Though after the age of eighty, then the the sex differentiation becomes a little bit less noticeable. So, it's about 1:1 after the age of 80.

Family history is a big one. Having a first-degree relative who had a triple A increases your risk of developing one up to 12 times. So, there is some genetic component to it. Even while there is some connective tissue disorder such as Marfan's syndrome or Ehlers-Danlos syndrome. Most people who have a family history of triple As don't have one of those names diagnosis so we don't really know for sure what the genetic component is, but we do know that there a genetic component. Other things that can increase your risk, smoking whether nor or in the past is a risk factor for having a triple A, high blood pressure; atherosclerosis, which is hardening of the arteries; and diabetes are also the common ones that can also increase the risk of triple A.

Host : Yeah. Wondering if there's any signs or symptoms. One of the things I've learned, Doctor, in hosting these is that a lot of these things are sort of silent, if you will, right? Silent killers in some cases. In other cases, just silent. Are there any noticeable signs or symptoms? Does anyone sort of feel pain down, feel something going on? How does that work?

Dr. Elizabeth Blazick: Yeah. Triple A is that classic silent killer so to speak.

Host : Okay.

Dr. Elizabeth Blazick: Far and away, most people feel no symptoms. And the triple A is often diagnosed when some sort of imaging test is done for an unrelated reason and they, oh, happen to find this triple A there. Those who do have symptoms, the most common ones is feeling a pulsation in in the abdomen, particularly in people who are a bit on the thinner side, sometimes having back pain or groin pain or even sometimes sores on the feet can develop from when there is plaque in the inside of the aneurysm, so to speak, that will embolize down and cause sores in the toes.

Host : Interesting. Yeah. Again, you know, I have the pleasure of hosting a lot of these and learning a lot from experts and, you know, it's one of those things where, well, why would someone associate something with their feet their toes with a triple A, and it's good that we have experts and leads me to want to talk about diagnosis. You mentioned earlier the importance of early diagnosis before it ruptures. So, how do you diagnose triple As and you mentioned that sometimes they're found kind of accidentally looking for something else, right? Some other screening. But is there anything specifically that you screen for looking for triple As?

Dr. Elizabeth Blazick: Triple A, while sometimes it can be felt or you might suggest it if you feel a strong pulsation on physical exam, you can't diagnose a triple A without some sort of imaging study. And so, the most common one that we use is an ultrasound, so similar just like you would for when you're having like , you know, baby ultrasound or ultrasound of the heart.

Host : Sure.

Dr. Elizabeth Blazick: We can use an ultrasound to look at the aorta to see if any aneurysm is there or not. The other most common way way to interrogate this or to evaluate for this is with a CAT scan. That can oftentimes give us a little bit more detail about the size and the anatomy of a triple A. So far and away, I think that most of the time now if people end up going to an emergency room with any sort of belly pain or even just, you know, relatively straightforward things. They're often times getting a CAT scan as part of the workup of that.

So, in recent years with the increase availability of CAT scans we've seen, far and away, that's the most common cause of how people find about this is they go to the emergency unrelated issue, they get a CAT scan and "Oh, by the way, you have a triple A. You need to go see a vascular surgeon." While that's the most common way that people get diagnosed, I think one of the things that we as vascular surgeons trying to do and part of the reason we're going out and doing these podcasts, is to increase the public of this diagnosis and realizing that even if they haven't for whatever reason gotten any CAT scan, ultrasound, that in certain patient population, we do recommend doing a screening.

So right now, Medicare covers an abdominal aortic screening ultrasound if you have a family history of triple As or a man between the ages of 65 and 75 who have smoked at least 100 cigarettes in their lifetime, which is not really a lot. But that's what it takes according to Medicare to be considered a former smoker, is 100 cigarettes in their lifetime.

Host : Yeah. It makes me wonder, you mentioned that 200,000 roughly, you know, new diagnoses every year, which seems pretty high. As you said, it's pretty common. It makes me wonder are we just diagnosing things better? Is there more accessibility to CAT scans and ultrasounds and things? Is that why, maybe one explanation? oR is it just that triple A's just on the rise.

Dr. Elizabeth Blazick: That's a great question, and it's probably an unanswerable because we don't really know the denominator, because triple A rupture is one of the most common causes of sudden death. So, you know, unfortunately, an older person, they might be found at home, they might have passed in their sleep. And far away, a lot of those may not necessarily get any sort of postmortem examination or autopsy to find out what the cause of death is. So, we may not ever know exactly what caused those people to pas s away.

The other thing too is there's going to be a proportion of patients who go on, live their life and may die for other reasons, and they might have had a triple A. It wasn't their cause of death, but they might have had one. So when you don't really know that denominator of people who have a triple A, going to be really hard to say what the overall rate is going to be. But we do know that we have gotten a bit better at diagnosing these and using the diagnostics as we mentioned. I think that the use Of CAT scan has become far more prevalent. It's become far more available in different Healthcare systems. And so, a lot of people are coming in with a CAT scan that has diagnosed this.

So, that's a great question. I don't know if the screening really moved that needle as much as just having more accessible CAT scans and ultrasounds for other reasons to other clinicians like primary care doctors and ER docs that have found this diagnosis and then referred them to us.

Host : Right. Well, either way, the case as you say, a lot of new cases every year, a lot of folks having triple As and may not even know it. But let's say, for the ones who do, the ones who've been diagnosed, what are the treatment options?

Dr. Elizabeth Blazick: So, first and foremost, if a patient gets sent to me with a triple A, we're going to sit down, I want to talk to them about those things that we talked about before. So, their history of smoking, are they currently smoking, because that is one of the most controllable risk factor that we have. You know, we can't change your age, we can't change your sex, but we can change your smoking status. So if you are smoking and you get diagnosed with a triple A, expect to sit down with us and we really, really strongly recommend it, that whatever it takes to quit or at least cut down on smoking. We do know that pulmonary disease and kidney disease are also other conditions that can lead to tougher outcomes when people are diagnosed with triple A. So, anything that's controllable in that realm, which again often comes back to the smoking. But we want to make sure that their kidney disease is stabilized as we can make it, that their lung disease is a stabilized as we can make it. High blood pressure is another big one. So, we really want patients to have their blood pressure well-controlled.

Diabetes is another risk factor. And that's something that if there's any room for better control of the diabetes, that's going to be the first part of it. And then, we've also seen that even in patients who have small aneurysms, that if they are overweight, losing weight is something that can improve their outcomes whether or not that actually helps to slow the growth of the triple A, we don't know for sure. But there may be some evidence to that. But if those patients ever do need surgery for their triple A, that we know that being of a leaner built and a healthier weight, they're going to have better outcomes from that. First and foremost, regardless of the size, there are the things that we're going to talk about.

So, not every triple A needs to be fixed and we do have size criteria that we use roughly to determine those patients who are going to continue to watch this closely with exams every year so or if we're going to start talking about surgery. And that is really based on the size of the aneurysm. So for men, we generally use a cut-off of 5.5 cm. For women, we use a cut-off of about 5 cm. And that is because, quite frankly, women have smaller vessels than men. I'll tell your patients that your abdominal aorta should be be about the diameter of your thumb. So, you can use that as kind of a marker of what it should be. And when I use that 5 cm in women and 5.5 cm in men, how much bigger that is from the normal diameter of the aorta.

Host : All right. So, addressing the risk factors for us, right? Some of these are on us, the patients. There is no magic pill per se. And then, obviously, surgery may be indicated in some folks depending on the size, age, sex, you know, a bunch of factors. I just want to give you a chance here at the end. Final thoughts, takeaways when we think about preventing triple A, treating triple A or just thoughts in general about triple A. I'll leave it to you.

Dr. Elizabeth Blazick: So, i think that knowing your family history is going to be important. If anyone in your family has had a diagnosis of aneurysm. Even if you're not sure where in the body it was, you should bring that up with your primary care doctor and talk about being screened when you get usually over the age of 65. And generally speaking, it's a one-time screening. If at the age of 65, you haven't started to develop an aneurysm, it's unlikely you're going to. So, really, it's not something that needs to be done year after year if there's no triple A. If you're smoking, please quit smoking. That's definitely going to be of that.

And remember to control the things you can control. If you are a diabetic, then whatever we can to make your diabetes under better control. If you're overweight, then a combination of diet. So, a good healthy diet and exercise is going to be helpful on so many fronts that's going to help decrease your risk of cardiac disease, of stroke as well as triple A death. Keeping your blood pressure under good control, that usually requires a pretty regular checkup at home. So, I tell my patients who have high blood pressure and triple A to go get a blood pressure cuff at home, know your blood pressure because it's not just a reading once a day or once every few months when you got to see the doctor. We're going to want to know where your blood pressure runs every day because it's going to change minute to minute. I tell people the more data you can give your doctor, the better they're be able to guide you in controlling these other conditions.

Host : Yeah. As you say, there are things that we can control and things that we can't, right? So if we can't undo our family history, we can't make ourselves younger even though we might want to. You know, having your blood pressure taken once a year to your physical, yearly physical exam, is probably not enough. So, great words of advice from an expert today. A lot of good education here. I appreciate it. Thanks so much.

Dr. Elizabeth Blazick: Great.

Host : And for more information, please visit our website at thevascularcaregroup.com. Thank you so much for listening to Answers in Vascular with the Vascular Care Group. I'm Scott Webb. Thanks for joining us.