Thoracic Aortic Aneurysms: Catching the Signs Early to Avoid Serious Complications

Deborah Howell (Host):[00:00:00] Welcome to the podcast. I'm Deborah Howell. A thoracic aortic aneurysm is a weakened area in the body's main artery, the aorta, which causes the vessel to widen significantly. If not treated properly, and if not treated promptly, can cause a tear in the aorta and lead to sudden death. Dr. Rodney White, the Medical Director of Vascular Surgery at Memorial Care Heart and Vascular Institute at Long Beach Medical Center, joins us to explain what a thoracic aortic aneurysm is, its symptoms and when to receive treatment. Welcome Dr. White.

Rodney White, MD (Guest): Hi, how are you, Deborah?

Host: Wonderful to have you with us. So what is a thoracic aortic aneurysm?

Rodney White, MD (Guest): Well, you did a good job introducing that. The [00:01:00] aorta is the big blood vessel that comes off your heart and then curves around up near the neck, gives off blood vessels to the head and arms, and then heads south through the body to the abdomen where it again, gives off branches to the belly, the visceral, what we call visceral organs, the stomach, the liver, and the intestine, and then about the level of the belly button, it divides and gives an artery off to each lower leg.

So when we talk about the aorta, then we're talking about from the heart all the way down through the main blood vessel to the really the lower abdomen.

Host: So it's fairly important, you might say.

Rodney White, MD (Guest): Well, yeah, it's critical to carry blood flow in any one of those circulations. And over time, as symptoms develop with any of those particular areas, then you can see it covers [00:02:00] a lot of territory. So it may present as symptoms, something like people having headaches, they pass out. They have pain in their neck, even a stroke. And as it gets down through the chest to the belly, then it can affect any of those vital organs and present with what we call ischemia, meaning, you know, a lack of blood flow to any one of those, which is not good, so.

Host: So how and why do thoracic aortic aneurysms occur?

Rodney White, MD (Guest): Well, there's several things. One is, there's a family genetic history in certain patients where if there's a family history and they know about this, then that's a signal to do early screening and to understand the disease a little bit better. And, the patients that have genetic testing, this is an area that's developing very quickly where, as you see [00:03:00] in just the current medical literature, a lot of genetic tests for many diseases and there are now screening tests that are being done for what would be specifically aortic disease early within a family.

Host: Mm-Hmm.

Rodney White, MD (Guest): Beyond that, then as any of us get older, the aorta tends to dilate, it tends to get a little stiffer, and if there's what we call atherosclerosis, the degenerative process that can occur naturally in the aorta, then there can be other symptoms like pieces of that material breaking off and what we call embolize or go to another critical circulation and cause a blockage.

Deborah Howell (Host): What are some signs and symptoms of thoracic aortic aneurysms?

Rodney White, MD (Guest): Really it's unusual pain that a patient experiences that persists over a period of time, particularly [00:04:00] in the chest and back, can also present as belly pain. The other thing is that females tend to present with a more atypical pattern. Normally, you hear in contemporary broadcasts about if you have an unusual pain or something, and they relate that really to substernal pain or, chest pain.

But in females, pain anywhere in the chest or even in the belly can present a little differently than it does in males. So there is a difference between males and females and how they can sometimes present as pain.

Host: Okay, good to know. Are there any risk factors that can contribute to a thoracic aortic aneurysm?

Rodney White, MD (Guest): Well, the one is, as I mentioned, family history. The other is all the other things you hear about contemporarily bad diet, smoking. Those are the two main ones. There are also other disease [00:05:00] processes that can affect that, which we call inflammatory. And some of those inflammatory diseases can also affect the aorta.

So it falls into couple of different categories, but they're all basically related to disease that progresses over time, and that anything that the patient does as part of their lifestyle that exaggerates that risk, then, you know, escalates the risk.

Host: All right, Dr. White, let's talk about some of the complications that can arise from a thoracic aortic aneurysm if left untreated or undetected.

Rodney White, MD (Guest): The biggest one you already alluded to, as the aorta dilates, it can eventually, it's kind of like a, if you think about a balloon. As a balloon gets larger in size, the wall gets weaker, and it can get to a certain size then where it can break. So, one of those complications is that the aorta gets to a critical size where [00:06:00] it can break. And that's a catastrophic situation, obviously, where very quickly you lose all your blood into the chest cavity.

Host: Not optimal. Is that what they call an enlarged heart?

Rodney White, MD (Guest): No, the enlarged heart is really referring to the heart itself, where the organ gets enlarged over time. One of them can be in athletes and that sort of thing, where they train a lot. That's not necessarily a risk factor, but it's in that enlarged category.

The other enlarged heart scenarios are that is the heart gets diseased mostly related to blood vessel blocks, then the wall gets weaker. And it tends to dilate, and it's that same sort of principle. The bigger it is, then the less likely it is to efficiently pump.

Host: Can you discuss for us the importance of regular screenings and annual well exams for detecting these [00:07:00] aneurysms?

Rodney White, MD (Guest): Yeah, there's a lot of programs now available and even some in the older age groups where patients are eligible for a screening that looks with the ultrasound, much like you would use the ultrasound to look in a pregnant lady's belly at the fetus, you can also look at the aorta in the abdomen and see if it's enlarged or has any abnormal configuration.

In the chest, it's different. The ultrasound won't transmit through the air in the lungs.

So, in the chest, the scans that we do now, particularly CT scanning that many people are familiar with,

or other sorts of diagnostic tests like magnetic resonance, something like that. So any of those would pick up these abnormalities in the aorta.

Host: Okay, good to know. And how can people prevent a [00:08:00] thoracic aortic aneurysm from happening?

Rodney White, MD (Guest): Well, one is good luck. The other is to pick your parents right, obviously, so you don't have that genetic characteristic. Regular exercise, keeping your heart and the blood vessels healthy, and then it's diet. Don't smoke and don't do any of the things that we know, particularly relate to degeneration of the aortic wall.

Host: Yeah, basic wellness. What should someone do if they think they're experiencing a thoracic aortic aneurysm?

Rodney White, MD (Guest): Well, if pain, again, persists in any abnormal pattern, particularly in the chest, or again, as I mentioned, in the females, lower down, even in the belly or in the back. If those sorts of pains persist, if they're new, that's a signal to go to an emergency room and tell them what you're experiencing. And in that setting, if it really persists, then they'll be able to do [00:09:00] one of these scans to take a look.

Host: Okay, I have just two more questions for you. What are the treatment options for thoracic aortic aneurysms?

Rodney White, MD (Guest): One is a conventional operation, which has been around for, oh, 30 or 40 years. That involves opening the body cavity and actually replacing the aorta with a fabric tube that then eliminates the aneurysm. The other newer treatment that continually progresses now is what we call endovascular repair, where we can, through the vessels in the groin, introduce catheters that have these graft materials combined with self expanding metals that will, once they're inside the appropriate part of the body can open up and actually eliminate, block off or circumvent those aneurysms or other lesions.

Host: [00:10:00] Wow, that's incredible.

Rodney White, MD (Guest): And that's moving very quickly. So like everything else, it's what we call more minimally invasive surgery and catheters that treat these kind of lesions are developing very quickly.

Host: That's excellent news for patients. How is Long Beach Medical Center unique in how they care for aortic aneurysms?

Rodney White, MD (Guest): Well, first off, it has a, uh, really world class group of cardiac and vascular surgeons that really focus on this disease process, so it's not only to be able to do those open operations, but we do many of the newer procedures, the endovascular devices have become available. And we're involved in studies for newer devices that really, you know, treat the aorta along its entire length for not only the aneurysms, but for what we call occlusive disease where they can actually get blocked off also.

Host: Well, that's fantastic for all. We want to thank you so much, [00:11:00] Dr. White, for your time and your expertise today. We really enjoyed having you on the podcast.

Rodney White, MD (Guest): Uh, it's a pleasure to be with you. Thank you.

Host: Thanks again, and if you'd like to learn more about thoracic aortic aneurysms and heart care, visit memorialcare.org/lbheart.

Or you can call 844-662-6484. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.