Abdominal Aortic and Thoracic Aneurysms | Q&A

Abdominal Aortic and Thoracic Aneurysms | Q&A


[MUSIC] An abdominal aortic aneurysm
is a abnormal dilation of degeneration of
the abdominal aorta, which is a main blood
vessel within our abdomen. It can cause it to enlarge,
bulge, or dilate over time and place it at risk of rupture. That rupture can be potentially
fatal to the patient. [MUSIC] A thoracic aortic aneurysm
is an abnormal dilation, or enlargement, of the aorta
within the chest. And in some cases, that can be
due to degeneration secondary to aging or hypertension or
genetic influences. And it can also be due
to aortic dissection, which is where the different
layers of the thoracic aorta start to delaminate and
tear, and again, place the patient at risk for
rupture. [MUSIC]>>Aneurysms are caused by
a degeneration of the aorta, where it begins to balloon and
get bigger and put you at risk for rupture. The most common risk factors for
aneurysms are a history of smoking, a family history of
aneurysmal disease, or genetic disorder such asMarfan Syndrome
or Loeys-Dietz Syndrome. [MUSIC] Aneurysms are typically detected
incidentally in patients who are undergoing an ultrasound,
a CAT scan, or an MRI for other reasons. Your doctor may also feel
a pulsatile abdominal mass, which signifies an enlarging
abdominal aorta. [MUSIC]>>Thoracic aneurysms can
cause a variety of symptoms. Most commonly we believe that
symptoms of a thoracic aneurysm be something simple as
chest pain or back pain. However, the type of pain is
very specific in that it’s pulsing, throbbing pain and
often times, very severe, and quite different from the pain
that one might experience after raking too many leaves or
shoveling too much snow. [MUSIC] The most common symptoms of an
abdominal aneurysm are usually pain in the abdomen or the back. Sometimes the pain in the back
will wrap around the sides, as we call the flanks in medicine,
or even down towards the groin. As a matter or fact, the most
common error in diagnosing an aneurysm when it
starts to leak or rupture is that people
call it kidney stone. Because of the severity of the
pain as well the throbbing and intense nature of the pain
can be quite similar to a kidney stone. [MUSIC] In terms of patients who are at
risk for developing aortic aneurysms, there’s clearly
a strong family influence. And some of these can be related
to genetic influences that patients carry even from birth
all the way until older age. But in fact most aneurysms are
associated simply with aging, and to some level, hypertension
as well as cholesterol. But clearly smoking accelerates
the growth of aneurysms in almost every patient, regardless
of genetic influence or not. [MUSIC]>>The most common types of
aortic aneurysms are abdominal aortic aneurysms and
thoracic aortic aneurysms. Both of these types can easily
be treated with endo graphs or stent grafts that are performed
with minimally invasive techniques. Aneurysms that involve
the branches of the aorta that go to the kidney arteries,
the intestines, the liver, and spleen, represent more
complicated aneurysms. Because these vessels have to
be preserved during repair in order to continue perfusing
your kidneys and intestines. Most places across the country
repair these by open means with a large incision,
a long hospital stay, and a complicated
post-operative course. However here we offer endo
graphs or minimally invasive stent grafts to preserve these
branch vessels with stents and small incisions and
quicker recoveries. [MUSIC]>>Cholesterol as well as
genetic influences or genetic mutations can certainly incite
or inflame the development of aortic aneurysms throughout
the entire arterial tree. In fact, genetic influences
are probably more important for the patients who we see who
are younger, the 30, 40, 50 year old man or
woman who have an aneurysm. And cholesterol, as it relates particularly to
Atherosclerosis, might be more of an important mediator
of aneurysm development, particularly as
the patients get older and go through the process of aging. [MUSIC] Aneurysms are treated as they
begin to enlarge towards five or six centimeters in
overall diameter. But in fact the majority
of aneurysms we see at Hopkins were very
small, and the risk for rupture on an annual
basis is incredibly low. So in those patients,
we’ll follow them year in and year out, with ultrasounds or
CAT scans or MRI to make sure we safely follow their
aneurysms over time, and that there’s no increased
risk for rupture for the patient that they
can be at risk for. [MUSIC]>>Abdominal aortic aneurysms
are typically followed with ultrasound because it
is non-invasive and poses no radiation exposure. As the aneurysm gets bigger and
nears the threshold for repair, which is approximately
five centimeters, we typically perform a CAT scan
with intravenous contrast. Not only to determine whether
you’re a candidate for a stent graft, but also to determine which branch
vessels may be involved. Including the branches to
the kidneys, the liver, and the intestines. For thoracic aortic aneurysms, we almost always perform
CAT scans with contrast, because ultrasounds cannot
penetrate the chest wall. [MUSIC]

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