New Treatment for Aortic Aneurysm

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I'm Deborah Howell, and today we'll be talking about a new treatment for aortic aneurysm. Our guest is Dr. Jeffrey Altshuler, a cardiac surgeon at MemorialCare Medical Group and MemorialCare Saddleback Medical Center. Welcome, Dr. Altshuler.

Jeffrey Altshuler, MD: Good morning.

Deborah Howell (Host): Can you possibly tell us what a thoracic aortic aneurysm is?

Jeffrey Altshuler, MD: You know, aneurysm is just an artery that's larger than it should be. And thoracic aneurysms are just aneurysms that are inside the chest cavity. So the particular main one would be the aorta, which is the main artery out of the heart and courses through the chest into the abdomen.

Deborah Howell (Host): Got it. That's short and sweet. What are the symptoms of this condition?

Jeffrey Altshuler, MD: It can be associated with back pain typically, but a lot of times it can be asymptomatic until they cause problems in the patient.

Deborah Howell (Host): Let me ask you about that. Why back pain, do you think?

Jeffrey Altshuler, MD: It's where the pain is referred to. You know, sometimes people have heart attacks, they feel it up in their jaws, down their arms. This is where the pain is referred to from the aorta. As it enlarges, particularly if it enlarges rapidly, it can cause pretty significant back pain.

Deborah Howell (Host): Interesting. Cause you wouldn't immediately associate the two if you just wake up with terrific back pain. Okay, so how is thoracic aortic aneurysm diagnosed?

Jeffrey Altshuler, MD: The standard is a CAT scan typically using an intravenous dye to look at the size of the artery. Sometimes there can be some abnormalities noticed on a chest x-ray that would prompt further intervention.

Deborah Howell (Host): So it's rather difficult?

Jeffrey Altshuler, MD: It's not too difficult to diagnose. The other modality that sometimes where an aneurysm identified is on an echocardiogram. So somebody that may be having an echocardiogram to just look at their heart, part of the aorta is visualized and that can be noticed at that time.

Deborah Howell (Host): Okay, and so when would a patient with this condition come to see you?

Jeffrey Altshuler, MD: Typically they'll see a cardiac surgeon usually when it's first diagnosed to kind of help direct further treatment. Usually it's diagnosed either by their primary care doctor or a cardiologist doing an echocardiogram or sometimes somebody's in the emergency room for another reason, gets a CAT scan for another reason. One of the most typical ways we see this is people with a history of smoking get a CAT scan for surveillance for lung cancer and this is an incidental finding.

Deborah Howell (Host): Wow. Okay. So how is thoracic aortic aneurysm then treated once diagnosed?

Jeffrey Altshuler, MD: Depends on where it is and how big it is. Just the presence of an aneurysm doesn't necessarily mandate intervention. We kind of monitor the size, and when it reaches a critical size, which is about five and a half to six centimeters depending on a couple different factors, that's when we as surgeons would intervene. Classically it meant a big open chest operation. Now for a majority of these, we're able to treat them by a modality that's called endovascular treatment. Basically we go through the blood vessels in the groin and reline the artery from the inside, similar to someone having a stent in their coronary arteries.

Deborah Howell (Host): Is that considered minimally invasive treatment or not?

Jeffrey Altshuler, MD: Yes.

Deborah Howell (Host): Oh, it is. So what can a patient expect? They enter the hospital or a surgery center?

Jeffrey Altshuler, MD: Someone who's having endovascular treatment of a thoracic aneurysm would be an inpatient in the hospital. A majority of the time now we just do it with what's called conscious sedation or light sedation. We don't even need a general anesthetic to do it. Access the blood vessels in the groin, pass several wires and catheters and the devices up into position. Typically following this, the patient would probably be in the hospital two to three days at the most.

Deborah Howell (Host): Okay.

Jeffrey Altshuler, MD: And then recovery, there's really no activity restrictions that you would expect with someone that had an incision on their chest or their abdomen at all.

Deborah Howell (Host): And how large is any kind of scar or marking?

Jeffrey Altshuler, MD: Most of the time we just do it through the skin, don't even make an incision. If we have to make an incision to access the blood vessels in the groin, then maybe an inch and a half incision.

Deborah Howell (Host): That's what people always wonder, so that's why I asked.

Jeffrey Altshuler, MD: Most of the time we just do it right through the skin, don't even have to make an incision in the skin. Just with a needle stick.

Deborah Howell (Host): Rather amazing. Is therapy or rehabilitation needed?

Jeffrey Altshuler, MD: No specific physical rehabilitation, but patients with this have to monitor their blood pressure, make sure their blood pressure's controlled. Once you've had one aneurysm like this, you're at higher risk of having further problems. So it's not like having your appendix out where we can tell you go home, don't ever worry about having an attack of appendicitis again. You can't say this is a condition that has to be monitored.

Deborah Howell (Host): Okay, and how often?

Jeffrey Altshuler, MD: Usually if someone's had an endovascular procedure, we like to get another CAT scan at three months, six months, and then a year. And if everything's stable, maybe yearly after that.

Deborah Howell (Host): Sounds good. Now with American Heart Month coming up in February, is there anything you'd like to share with everyone regarding heart health and preventive care?

Jeffrey Altshuler, MD: Just take care of yourself and be proactive. Don't wait till you're, till it's two o'clock in the morning and you have the worst chest back pain you ever had in your life or take your blood pressure medications if you're on them. They're there to help you.

Deborah Howell (Host): Yeah, absolutely. And have that regimen so you never ever forget. Also, obviously, no smoking.

Jeffrey Altshuler, MD: Absolutely.

Deborah Howell (Host): What about diet?

Jeffrey Altshuler, MD: There's a million fad diets, but it's smart eating. Everybody needs fats, proteins, carbohydrates in your diet. Know what's good fats, bad fats, good protein, bad protein, good carbohydrate, bad carbohydrate, and portion control. Just monitor the amounts you're eating.

Deborah Howell (Host): And what about exercise?

Jeffrey Altshuler, MD: Anything you can do is helpful. Just being an active person. And it doesn't have to be get to the gym four times a week and sweat all the time, but just being active. Walking's great. Being a normal active person.

Deborah Howell (Host): Yeah. Even 20 minutes of walking a few times a week can really make a difference. Anything else you'd like to add, Dr. Altshuler?

Jeffrey Altshuler, MD: No, just be aware of your health and just be proactive and take control of your own health.

Deborah Howell (Host): I love it. Can't argue with that. Well, we really enjoyed having you on the show. For more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.