One Of The Deadliest Conditions: Abdominal Aortic Aneurysm (AAA)

aortic aneurysm scary word we're going to find out what it is how to find out if you have one how to treat it and sort of what's involved with dealing with an aortic aneurysm welcome to talking with docs I'm Dr Paul zalzel I'm Dr Brad weaning I'm Dr Bev Chen first of all to our viewers you're doing the right thing congratulations you're watching a video about your health that's amazing this is a good use of screen time kids this does not count in your screen time limit for the day well done so Paul has become your parent as of right now that's right Dr Chan is a vascular surgeon she has kindly given us some of her time and expertise to talk to you about aneurysm so let's start at the beginning but what is an aneurysm an aneurysm is when there's an outpouching so a weakness in the vessel wall and so it stretches out to about two times normal size okay yeah okay so a an out poaching or stretching out of a vessel wall and the one we're going to talk about today I think mostly is the aortic aneurysm so the aortic your biggest artery that runs out of your heart and down your whole body and feeds the blood to the different parts of your body so your aorta and I think we're going to focus on abdominal aortic aneurysms that's the most common one okay what's the deal so this happens because and everyone always is like well how do I get this and most of the time 90 is because of degeneration so think of as your body is aging it's not only your skin that's getting more relaxed and things like that same thing happens to the vessels so the elastin inside the The Vessel wall it actually decreases and so that's how you get that weakening of the vessel wall so that's 90 so beauty is not only skin deep yeah it's vessel deep for sure and so so aging is one thing that obviously we can't really control because we're all going to slowly get older are there any identifiable risk factors or things that people can potentially change throughout their lives to reduce their risk of getting something like this yeah so most risk factors are not changeable okay um so age can't really reverse aging process sex right so men are three to four more times more than females gonna get aneurysms um the one thing that can be changed is smoking history so if you've ever smoked even like one package of cigarettes in your lifetime then you're already at risk okay so if you've ever had a good reason not to start smoking this is it it increases your risk of an abdominal aortic aneurysm on the smoking side if you had one pack of cigarettes and are still smoker is it still worthwhile quitting from a vascular surgery perspective okay so I'll have patients who quit smoking they have an aneurysm we follow them and then I'll have the almost the same person and but they're continuing to smoke they're the ones where the aneurysm is really crazy right so they get worse yeah so I'm like okay we'll fix those ones faster thanks Brad you seem worried about that one pack of smoking in history in your lifetime being oddly nervous about that I'm definitely not nervous about it but I'd say for full disclosure and honesty in our channels you have I've made some bad choices in my life and I'd say smoking a couple cigarettes when I was younger would be part of them yeah I think telling everyone that's a bad choice too you know I'm comfortable with that because I don't do it anymore you know it shows that we're not perfect we are fallible okay all right moving on I don't I don't consume the chicken wings the dog or salsa does so my non-smoking now is probably gonna outweigh that I'm pretty sure the kale outweighs this way it's a wash it's a wash all right so we've got some risk factors for an aortic aneurysm are there any symptoms of an aortic aneurysm before it starts leaking or ruptures most patients will have no symptoms so they're like walking around like a ticking Time Bomb so I would say majority if they're already symptomatic so if they're already having like new back pain abdominal pain that's already when you know it's expanding it's at risk of rupture okay silent kill some people talk about maybe feeling something kind of they're heart pounding in their stomach is that a real thing can be but it'd have to be pretty big yeah okay so so now you've gone to your family doctor for some other reason potentially yeah someone's done a physical examination or another test like a CT scanner ultrasound for another reason they've seen this so what what's the normal size of your abdominal aorta so 1.5 centimeters 1.5 centimeters that's the diameter diameter and at what point do we start thinking or what time at what point do we call it three centimeters three centimeters okay so you got a three centimeter abdominal aortic aneurysm now what do you do now you're nervous obviously yeah do you automatically get referred to a vascular surgeon most of the times yeah yeah okay so you get referred to vascular surgeon someone comes in your office with a say a diagnosis of this yeah what do we do that so it depends what it looks like okay okay um look at the risk factor Factor um then it's it's it's surveillance okay so we would do either an annual ultrasound depending on the size once it gets pretty big then we'll reduce it to like every six months screening um like surveillance for with ultrasounds okay um because we want to kind of get to that size threshold where we're like I think it's time to to offer surgery you ran through a few we talked a few about some of the risk factors but now that they're in front of you in the office and you're trying to identify some risk factors so one is smoking but one is family history uh do and you mentioned hypertension is that a risk factor yeah hypertension diabetes diabetes surprisingly protective really okay yeah totally we don't love to mention it because obviously you don't know you don't it's not like you want to get diabetes to prevent aneurysm okay okay since we're on the prevention yeah what about high cholesterol yeah there's high cholesterol disease okay um yeah eating chicken wings chicken wings is that protective no okay so connective tissue disease yeah okay that's a risk factor as well height is a risk factor too so the taller you are you're also at risk right holy smokes okay yeah so these are just weird yeah okay we'll take it so these are these are the things that you look for when you're taking a history yeah okay um anything else to cover all the risks no so those are the sizes we have small medium and large correct so the three to four point five four point five to five five and then greater than 5.5 centimeters is that still used so men and women are different okay okay [Laughter] okay so now man 5.5 is when our our guidelines say to treat them in men regardless of sometimes yeah if no symptoms 5.5 and then looking at their other health factors like can they withstand a big surgery are they gonna you know do they have metastatic cancer or they're not sure so then we're kind of like well yeah uh females are smaller okay so five centimeters okay so a lot of people are like oh yeah you guys are just surgeons you just want to operate on all these aneurysms the reason that 5.5 centimeters or five centimeters in female is chosen is because your risk of rupture is much higher and once it ruptures your odds of successful treatment goes way way down yeah so if your aneurysm ruptures you have an 80 chance of not surviving the event and so we always talk about risk benefit ratio so those numbers five and five point five were found out through good studies to show that look the risk of rupture is now getting higher than the risk of surgery which tips the risk benefit ratio in the favor of surgery at that level or more because it can be potentially life-saving so now we've talked about the history the the look for the risk factors some sizes on physical exam if someone comes into your office what do you what do you look for on physical examination just feeling like a pulsatile mass okay so yeah palpation of the abdomen see if you can feel a pulsatile mass I did find one once when I was a resident I remember we were rotating through and it was like abdominal pain and it was a leaking one so that is that is a physical examination thing that you're vascular surgeon or even family doctor or primary care physician is going to do to to try and find this up and then we said we ordered the ultrasound is that your thing of choice reading of choice I mean it's it's not it's cheap for the government and it pick high pickup rate and doesn't have any radiation involved so then you're not worried about actually we have an ultrasound because of a family one of the three of us has had an older stuff it has dawned on me because I have a family history so my family doctor set me for an ultrasound which I'll I'll show everybody that ultrasound is a non-invasive test like you mentioned using sound waves that are higher than the frequencies we can hear humans can hear 20 Hertz to 20 kilohertz ultrasound is anything higher than that and they use it to get an image inside your body without invading your body and you get the gel put on the gel is an acoustic coupling gel because sound waves will bounce back from any interface and it was a relatively short test pawn and no no obviously that's right that's right so I'm going to show you this okay video however I just want to say beforehand since I'm donating my body to science here thank you because of the angle of the camera I'm like holding it like this it it makes it look like my abdomen is very hairy so I don't want to show I don't want any jokes oh my goodness I don't need Sasquatch sighting jokes or are you part Chia Pet joke I don't expect it from Dr Chan because I anticipate her brand of humor is a little more sophisticated yeah okay well let's have a look okay you know let's let the viewers judge it's an optical illusion there's a sound table here and I've got Samira the ultrasound technician hi Samira hi and she just bring some gel on my abdomen and then she's going to have a that's the ultrasound probe going on it you can see the ultrasound probe is pushing down while she's trying to get some images she's done my whole afternoon and now she's just focusing on the aorta which is why I'm here for a screening test Samira is my six pack abs getting in the way of the filming no not really oh okay too bad wow am I pregnant no [Music] it would both be rich she said I guess that was my heartbeat going so that's your proximal iodine okay so that's the Doppler ultrasound measuring the flow of my proximal aorta so she's moving down and it's a pretty firm push it's not uncomfortable but you can feel it so really nothing to be afraid of if you have to go get an ultrasound Okay so what remember you're wearing a sweater during the test I'm not wearing a sweater I told you it was an optical illusion because it's camera trickery not to mention the gel that's like Brill cream for the abdomen all right okay so that is an abdominal ultrasound add that to the list of things you can't unsee about doctors out there like him in his bath when we were doing our magnesium salts video I withdraw my consent I withdraw my consent for that video next time you watch this video it's not going to be me and they're getting an ultrasound it's good to me okay so now we have the diagnosis so let's talk about treatment so the first group of people that gets treated are the people that have aneurysms that are large enough that their risk of rupture is high so let's talk about the elective procedure so what do we do for this there's different types of surgeries there is the traditional open surgery so that's where we make the incision we would clamp above and below the aneurysm and replace that segment with a plastic tube graft okay and then sew it back so that's the traditional method there's a newer method and that was started back in 1991 um by a South newer 31 years old all right that's that's right that's the pace of medicine and then Canada takes forever just before the internet insane okay so the newer one is the endovascular repair so these are stent covered stent grafts that are put in um through the groin so little small incisions um and that's that's a easier procedure for patients to tolerate and usually with those ones that are in and out of hospital within two days so very exciting for patients and for surgeons yeah because the success rate is so much much less invasive okay yeah okay and the success rates for these surgeries are typically they're good so so if you look at the literature 30-day outcomes less than five percent risk of mortality with the open surgeries um 10 morbidity so if they have like a heart attack after surgery have to go on dialysis if they have like breathing issues stroke so that's with the open surgery with the endovascular repair it's about less than one percent chance of mortality the only thing is like it's still a discussion between the surgeon and the patient in terms of which method is better depending on the anatomy how the whole aorta is angulated because some does it relate to how close it is the kid needs it is yeah yeah so there are fancier newer uh stent graphs that can get closer to the kidneys and custom grafts as well so there I think I read where you can have like little else yeah mesenteric or the renals so for our some patients there is one company that will take your CT scan and make a custom graph that is only for you right it takes about six weeks though wow yeah and the graph is made out of it it's like a Gore-Tex okay uh for the for the actual material and then to actually reinforce that they're nitinal stents that's basically like hand sewn into them so so yeah I can understand so you're taking this graft yeah you're putting it through a small hole in the groin getting it to where it needs to be and then how do you make sure how does it a stay where it's supposed to be and how do you how do you advance it is on the end of a catheter or like so it's all like so the graphs are then CR like after it's made it's smushed in and put into these deploying devices okay um so it's kind of like a parachute we'll deploy it out and you kind of like open it how it stays is at the top depending on the manufacturer everybody has their own kind of like Secrets um but most of the time they have like little hooks on the and to to grab onto the wall of the healthy aorta to kind of you know get it to stay in place right um other methods there's like some ones that like use a glue sealant and how long does this procedure take on I like average sure an hour and a half okay so it's pretty yeah wow that's incredibly Innovative to to solve that medical problem and you can see that the innovation of these uh less invasive techniques uh reduce your mortality and your morbidity so mortality your risk of dying from the procedure and morbidity risk of something bad happening from the procedure go way down with these less invasive techniques which makes sense because we're not making a large incision to get at the aorta we're just making tiny incisions and putting the instruments and devices in through little holes in your body instead of like a you know 18 inch incision but it's important to address the main risk or main morbidity related to these procedures is all about blood supply so to your heart heart attack to your brain stroke to your kidneys dialysis to your stomach potentially yeah you could have a scheme of colon disease for sure for sure these are and these are not unfortunately totally uncommon but it is the nature of the operation it's not because something went wrong it's because you have a very difficult problem to solve for sure okay so how long let's say how to repair am I cured or um does this have a lifespan great question so we you can see no matter what even if it was an open repair versus the endovascular repair sometimes over time we see the aorta above it so the healthy that what used to be the healthy aorta can then degenerate into an aneurysm right okay so we can see that with this Dent graphs we are monitoring that a lot more closely compared to the open because there's about a 15 to 20 percent reintervention rate with the stent graph so there is some caveats with the newer technology um for sure and then with the open repair usually we'd have to do a CT scan at least every five years just to make sure we're not seeing new aneurysms okay so you can have an aneurysm above your graft or below your graph in your on your own tissue or even with the less invasive ones they may need some more intervention some parts might get included and you may need another intervention afterwards so nothing lasts forever but it's as close to a cure as you can get yeah if you have this condition for sure there's another group of people I'd like to talk about so the symptomatic group yeah so first the symptoms of a rupture are relatively straightforward you have drastically reduced blood supply to your entire body so severe pain weakness dizziness fainting you would pass out yeah right what about the person that has a leaky uh organic aneurysm so maybe just a small little leak yeah so they'll still have abdominal pain or back pain and it's patients will tell us that it's different from their usual back pain so it's something that doesn't go away completely and they just feel a little bit off and usually it's our non-complainers and it's like their family member like yeah you know what my dad never complains like a farmer yeah yeah and they're like oh finally get the man you're like oh they're leaking yeah okay so you've heard a lot about aneurysms and the symptoms that causes the severity the fact that you can die from it what you're probably wondering now is well how do I know if I have one should I go get screened for it should I go get tested let's talk about that the average person one of our viewers I was wondering well whoosh how do I know whether or not I should go get tested for an aneurysm so guidelines so Canadians decided for vascular surgery has screening guidelines out there so any man who is 65 years or older should it have at least a one-time ultrasound to look for it if there is family history I should be screened younger so between 50 to 55 should have at least a one-time ultrasound for females they say if it's 65 years or older and if they've had a history of smoking like even one package of cigarettes family history if they have other risk factors so like your high blood pressure cerebral vascular like brain uh things Strokes okay so yeah if you're watching and you're a male over 65 you should get an ultrasound screening yeah if you are a female with even one pack of smoking history over what age was it 65. you should get screened and then women in the absence of the other risk factors over 70 yeah should get screened as well and that's the Canadian guidelines are the American guidelines similar are they a little more aggressive it's a little bit more aggressive okay they're a little bit more aggressive in the U.S first for getting screened so those are guidelines that we follow in Canada and other parts of the world it may be different if you're worried about it definitely go speak to your primary care physician your health care provider and just say look here's my life here's my history should I get screened for it that is such a great summary of the triple triple A it sounds like it's so good like AAA yeah I play Triple A baseball amazing I have a triple in my Advent look out yeah so um take this information use it as you require share it with people that you know that do have this issue and if you like this video please like it subscribe to our Channel and by the way my ultrasound screening was negative okay well that's good for your concerns did they say it had to be redone because of the hair that was still a reliable test the hair did not plan this shoe the acoustic coupling gel acted like an abdominal Grill cream it made it look a lot worse than it is take my shirt off right now and remember you are in charge of your own health and thanks so much to Dr Chan for giving us this explanation no thank you we'll see you next time

Channel: Talking With Docs

Views: 302,111

Keywords: aortic aneurysm, abdominal aortic aneurysm, aneurysm, aortic aneurysm surgery, aortic aneurysm (disease or medical condition), aortic, aortic aneurysm fatal, aortic aneurysm signs, aortic aneurysm doctor, aortic aneurysm deadly, what is an aortic aneurysm, aortic aneurysm recovery, open aortic aneurysm repair, aortic aneurysm hereditary, aortic aneurysms, aortic aneurysm repair, aortic anerysm, aortic aneurysm symptoms, how to heal aortic aneurysm

Id: 7TdDRuaWYvw

Length: 20min 43sec (1243 seconds)

Published: Thu May 11 2023