Transcription:
All About Aortic Aneurysms

 

Caitlin Whyte: Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. I'm Caitlin Whyte. You may have heard of an aortic aneurysm, but did you know there are two different kinds? In this podcast, learn from Dr. Charles Fox and Dr. Nathaniel Dayes vascular surgeons at UM Capital Region Health, about what aortic aneurysms are, the difference between the two. Risk factors for each common symptoms and treatment. Dr. Fox, I'll start with you. Tell us what exactly is an aortic aneurysm and how is it similar to or different from other aneurysms in the body?

Charles Fox, MD: Well, an aortic aneurysm is a dilation of the aorta, and the aorta is the large artery that goes from the heart through the chest and down into the abdomen. When these get degenerative because of atherosclerotic disease or from other genetic disorders they start to dilate. And what makes them unique is they can rupture and they can be painless. So patients don't always recognize that they have an aneurysm in their body. And when they get to a certain diameter, they have a much higher risk of rupturing.

And when they rupture, Chances of surviving that become very slim. So, the reason we're talking about this is because we think it's very important to have screening, particularly our patient population in the Capital Region.

Caitlin Whyte: Wonderful. So, Dr. Dayes, what is the difference between a thoracic aortic aneurysm and an abdominal aortic aneurysm?

Nathanael Dayes, MD: Well, it's mainly the location in your body like Dr. Fox outlined, that major blood vessel, the aorta travels from your heart and goes through your chest and splits in your pelvis to feed both of your legs. And along the way branches come off of it to help. Profuse certain organs and we consider, you know, aneurysms that are in the chest cavity, kind of right after that left subclavian artery. We consider those descending thoracic aneurysms that a vasa surgeon would treat. Prior to that left subclavian artery. Vascular surgeons still do treat, but sometimes there's, the cardiac surgeons are involved and then the abdominally aneurysms are kind of like from your belly to the pelvis, you know, adamant to the pelvis.

Caitlin Whyte: Gotcha. So tell us about the symptoms, Dr. Fox of the thoracic aortic aneurysm and of the abdominal aortic aneurysm?

Charles Fox, MD: Okay. Well the symptoms can be very different because the aneurysms when they're in the chest are high in the neck area can compress important structures that give symptoms. Whereas the abdominal aortic aneurysm generally doesn't compress anything that would cause pain. So one of the symptoms is pain, and it can be pain in the flank or pain in the back. If it's compressing the airway, then the patient may feel short of breath if it's in the chest, or it might affect some of the nerves that affect our voice.

So you might have hoarseness or difficulty swallowing or difficulty breathing or pain, but in the abdominal, Aorta generally patients might experience pain, but the most common symptom is just feeling dizzy or feeling like they're faint. And that's because at that point their aneurysm is becoming leaky and they're losing blood into the area of the back. And if you lose a unit of blood, then the patient might pass out.

Nathanael Dayes, MD: I'd like to just add on to what Dr. Fox was saying, for that third question you asked. He's very right-wing to this. Majority of these patients are not gonna have symptoms. You know, most of these patients are, are asymptomatic and they'll find out that they've had that they have this new diagnosis of a thoracic aneurysm or abdominal aneurysm mostly incident. They'll get an imaging study for a gallbladder or they have kidney stones and then the report will say aneurysm. And, that gives patients a lot of stress when they see that, especially when they're told by whoever is reading the report to them. So it's very important to let patients know that, you know, they may feel completely fine and still have this deadly.

Charles Fox, MD: I think that's a good point, Nate. And I also think that a lot of people get told they have an aneurysm when they're nowhere near the treatment criteria.

Nathanael Dayes, MD: And I encourage patients to Come in and, and let us, you know, tell you kind of what the treatment options are and e even if you don't need treatment, it's good to get on the radar of a vascular specialist, not to kind of wait till the last moment, wait till that moment where you're like, Dr. Fox said you're leaking and about to rupture. It's better to come in and have a relationship with the vascular specialist as early as possible .

Caitlin Whyte: So Dr. Dayes, what are the most common causes of these two conditions?

Nathanael Dayes, MD: You know, aneurysmal generation of aneurysms is multifactorial. It's a systemic process that's generally felt to be due to alterations in wall of your arteries. Now the walls lose structural protein and wall strength, and then they expand. I mean, you, you see the greatest expansion in smokers Do. So that's probably the biggest cause. But there's also these patients, and I'm kind of maybe getting ahead of myself. They tend to have a family history. They may have other artery aneurysms. They definitely also have a history of hypertension and men are more at risk. So I think those risk factors or causes kind of are important to highlight .

Caitlin Whyte: Well, let's talk about risk now. Dr. Fox, who is most at risk for developing one of these conditions?

Charles Fox, MD: Certainly family members are at risk when they've had a first degree relative that's had a history of an aneurysm. So we usually take a careful family history. Patients with genetic disorders like connective tissue conditions are higher at risk like Marfan Syndrome or ELers Danlos. In general, men over the age of 65 who have a history of smoking are at risk and can get complimentary screening because it's a Medicare issue where we can identify people that are at risk in the population.

Caitlin Whyte: And Dr Dayes, when should someone seek medical attention for this, especially with the lack of symptoms? What preventative treatments or appointments should someone have if they are at risk?

Nathanael Dayes, MD: So I would seek immediate medical attention if you have abdominal pain, back pain, or flank pain, and you know you have aortic aneurysm, whether it's thoracic or abdominal. And I should say abdominal and chest pain, but in general, patients who have a positive family history, if they're smoking, even if they have high blood pressure, these patients should probably seek an evaluation by a vascular specialist. And in terms of preventive treatments, and this is probably just good advice in general, you know, Limiting tobacco use or stop smoking is probably the best advice you can give as a vascular specialist.

Caitlin Whyte: And Dr. Fox. Turning to you, what treatment options are available for an aortic aneurysm?

Charles Fox, MD: Okay, well first of all, as Nate said, the most important part of our treatment is the medical management of vascular disease. And so we encourage exercise, proper diet, avoiding cigarette smoking, controlling blood pressure. If patients are diabetic, then it's important to have good glucose control. And understanding that there's a surveillance process for aortic aneurysms. There's size criteria, and as Dr. Dayes said, we want to meet these patients as soon as possible, and then sort of get a picture of the patient's medical history and their surgical risks.

And start the medical therapies and then put them on a surveillance plan where we look for changes in size when the patient's finally ready. Actual surgical treatment. We sort of split the patients into two groups. Those that need an open surgical repair or those that can get a minimally invasive approach with stents. And there are various types of stents and modifications of stents that we all do in our practice that almost makes any patient, a candidate for minimally invasive procedures and stenting. And then it gets rather complex. But we usually do a CAT scan that allows us to do the proper measuring and sizing and planning for which option is best.

Caitlin Whyte: Thank you. Dr. Dayes, what are the best ways to prevent getting an aortic aneurysm? I know we've talked about smoking and lifestyle, but is there anything else.

Nathanael Dayes, MD: Those risk factors we mentioned earlier are probably the best things to address. The lifestyle exercise and curtailing tobacco use, addressing your blood pressure ,or your diabetes. Like Dr. Fox said those are the things that patients can focus on to help prevent their risk. And again, being in close contact with either your primary care physician or vascular specialist to get the appropriate screening test is important.

Caitlin Whyte: Great. And well Dr Dayes, I'll stick with you. Is there anything else you'd like to share with our audience? Any other takeaways?

Nathanael Dayes, MD: Well, I would say I like the, our audience to feel free to contact our office. I know myself and Dr. Fox are more than happy to set up an appointments. To talk to patients about aneurysms and what they can do to decrease their risk, even if you're not at that surgical threshold. I stress these developing relationship with patients early, kind of walk them through the process is important. So, you know, feel free to contact us and come in to get an evaluation if you meet the criteria we discussed.

Caitlin Whyte: Wonderful. And Dr. Fox, same last question to you. Any last takeaways from this conversation? You want people to leave with?

Charles Fox, MD: Yeah, no, I think Dr. Dayes really summarized that very well. You know, we're just interested in talking to people and getting to know them and outlining a treatment option and seeing them as early as possible.

Caitlin Whyte: Well, thank you doctors for sharing your time and your knowledge with us today. You can find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again.