Amanda Wilde (Host): This is Health Talk presented by the Valley Health System. I'm your host, Amanda Wilde. And my guest is vascular surgeon, Dr. Rohan Kulkarni. We're focusing on a condition that affects millions of Americans, aortic aneurysms. Dr. Kulkarni, welcome. Thank you so much for being here.

Dr. Rohan Kulkarni: Thanks for having me.

Host: So, what is an aneurysm?

Dr. Rohan Kulkarni: So, an aneurysm is a weakening of a blood vessel. It can happen throughout the body, in the brain, in the chest. The ones that we deal with most frequently as vascular surgeons are aneurysms that develop in the abdomen. They can also develop in the legs, or like I said, in the chest. And we manage the entire breadth of aneurysms, from the collarbone to the toes as vascular surgeons.

Host: So, they can happen in many, many places in the body. What causes an aneurysm?

Dr. Rohan Kulkarni: The most prevalent risk factors, what we believe leads to aneurysms is a combination of smoking, which is by far the number one risk factor, and then, age, as you get older. It tends to be more common in males and in patients that have high blood pressure.

Host: And what is the danger of the weakening of these vessels that define an aneurysm?

Dr. Rohan Kulkarni: So to make it as understandable as possible, the blood vessel is a tube. And as that tube weakens, it begins to balloon. And if you can picture a balloon in your mind, at a certain point, when that balloon gets larger and larger, it can pop. And so, similar to that, aortic aneurysms, once they get above a certain size, they have a certain risk of popping per year. And when they pop, it's very, very bad for the patient. And there's a very, very high fatality rate for it. So whenever we diagnose these aneurysms, we try to fix them once they get above a certain size.

Host: And how do you diagnose aneurysms? Are there signs and symptoms that people come in with? How do you screen for those?

Dr. Rohan Kulkarni: Yeah. Unfortunately, a lot of people that know they have an aneurysm. It is either at the time when it pops and they notice severe abdominal pain, chest pain, back pain. And the other half of people that are diagnosed with aneurysms is actually because they went in and had a scan for some other reason.

So when you have an aneurysm, and it has not popped, the most common way of having a diagnosis, actually you went in for something else, what we call an incidental finding. But as we begin to identify and appreciate the prevalence of aneurysms in society, there have been guidelines that have been trying to identify these ahead of time.

So, any male above the age of 65 with any smoking history is available for a one-time free Medicare ultrasound of the abdomen to diagnose and identify any aneurysm before it gets to a stage where it begins to cause problems. But this is a new initiative that the Society for Vascular Surgery, and Medicare has really been putting out over the last, say, 10 years. But for the most part, a lot of these are found on accident or after they've already ruptured.

Host: Are there any signs or symptoms of aneurysms that we should be aware of?

Dr. Rohan Kulkarni: One that a lot of people like to think of is what we call a pulsatile abdominal mass. Say, you're laying on your back and you have your computer on your belly, you'll notice the computer going up and down. Some people, you can actually press on the abdomen and feel it. But unfortunately, no, usually, there's no sign or symptom that people have to identify it ahead of time.

Host: Are there risk factors that are associated with aneurysms? You mentioned smoking, so we know that, and age.

Dr. Rohan Kulkarni: So, smoking is far and away the largest risk factor, and that's why anyone who has smoked in their life, male, above the age of 65, is eligible for a one-time screening. Hypertension, persistently high blood pressure is another risk factor. It does travel in families. So, there is a genetic component to it. And then, there are certain connective tissue disorders. These are Marfan's, Ehlers-Danlos. These are usually things that we can identify based on the appearance of a patient or they'll have a known family history. But those are pretty rare. Far and away, the number one cause and risk factor for these is smoking.

Host: Well, I was going to ask: can lifestyle affect your risk factors, genetic or otherwise? Obviously, not smoking is one of those things. Are there things you can also proactively do that are lifestyle adjustments?

Dr. Rohan Kulkarni: Right. So, keeping a close eye on your blood pressure, keeping a close eye on your cholesterol. High cholesterol also has a tendency to be associated with aneurysmal development. We can't say that it's necessarily a cause, but a lot of patients that have aneurysms do have a history of high blood pressure and high cholesterol. And like we already mentioned, smoking is far and away the number one.

Host: And what are the current treatment options that are available if you do happen to find out you have an unruptured aneurysm?

Dr. Rohan Kulkarni: We as vascular surgeons do not go to repair an aneurysm until the size crosses a certain threshold. So in males, it's 5.5 centimeters. And in females, it's 5 centimeters. And the reason we make that distinction is because below that size, the yearly risk of rupture is lower, even though it's low risk of the operation itself.

So once it reaches that size, there's a couple of different ways that we approach aneurysms. The tried and true gold standard way based in the past was to make a large open abdominal incision. We go straight down to the aneurysm, we open it, sew a graft in and fix it that way. The way that it's done most often now is what's called endovascular, the minimally invasive technique. So through two small pokes in the groin, we're able to place IVs into the blood vessel. And we can fix the aneurysm from the inside that way.

Host: So, do you consider that a big advancement since it is minimally invasive?

Dr. Rohan Kulkarni: It is a huge advance in aneurysm treatment and aneurysm surgery. There's no question about it. It's reduced the risk of short-term mortality, hospital length of stay, complications, especially on older patients who don't have as good of a heart. It is definitely the way that most vascular surgeons try to treat these aneurysms now. But there's certain anatomy that still requires us to do the open operation. And I'd say the best thing about vascular surgery is we're trained on both. So whether you have a type of anatomy, which is better for the open, or if you're okay for the minimally invasive, we can offer you either option. But we always try to do the minimally invasive when it's the right thing to do for the patient. And when we recommend an open surgery, there's big advantages for that as well. But we try to do the right operation for the right patient at the right time.

Host: With the game changing advancements in research and technology in many fields of medicine, what do you look forward to in those areas to improve outcomes for your patients?

Dr. Rohan Kulkarni: In the world of vascular surgery, technology is continually pushing us forward. The advancements that we gain on a year-to-year basis is unbelievable. So as far as aneurysm technology goes, the endovascular graft that was developed about 20 years ago is constantly being improved upon. So, aneurysms that required open treatment, difficult anatomy, the technology that's coming out and the way that we're able to treat these aneurysms through a minimally invasive technique is advancing. Things that we had to do open surgery for just five years ago, we're able to approach from a minimally invasive standpoint. So as the technology evolves and it is rapid, it's really helping us to better treat our patients and get them in and out of the hospital faster and live a longer, healthier life.

Host: Dr. Kulkarni, what advice would you give to someone who is looking to reduce risk of developing aneurysms?

Dr. Rohan Kulkarni: The best thing you can do for yourself is to not smoke. And unfortunately, if you have smoked, this can cause problems with your blood vessels even after you've stopped. But if you can stop smoking and stay off cigarettes, that is far and away the best thing that you can ever do for yourself.

Other than that, seeing your cardiologist, your primary care doctors, making sure to keep a close eye on your blood pressure. Keep a close eye on your cholesterol. Being active is always beneficial to every patient, no matter what problem you have. And then, being aware of your history, understanding your genetics, knowing your family history. You know, this is very difficult for some people. But whenever a patient comes in and they know their family history, it's always a huge help for us as well. But yeah, number one thing is don't smoke. And if you have, try to stay off of it and not restart.

Host: Well, Dr. Kulkarni, thank you so much for the advice and the insight and the work that you do as a vascular specialist.

Dr. Rohan Kulkarni: You're very welcome. Thanks for having me.

Host: That was vascular surgeon, Dr. Rohan Kulkarni. To learn more, visit valleyhealthsystemlv.com. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. Thank you for listening to Health Talk, presented by the Valley Health System.

 Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.