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Prakash Chandran (Host): Thoracic aortic aneurysms affect approximately 15,000 people in the United States each year. And up to 47,000 people die each year from all types of aortic disease. Dr. Daniel Newton an Assistant Professor of Vascular Surgery at VCU Health, joins us today on Healthy with VCU Health to define aortic disease, the complications and risks, and how to treat it. This is Healthy with VCU Health. My name is Prakash Chandran. So, Dr. Newton, thank you so much for joining us here today. Could you just start by explaining what the aorta is and why it's important?

Daniel Newton, M.D. (Guest): Yeah, thanks for having me. So, the aorta is the main artery that comes out of the heart about an inch or inch and a half in diameter. And it supplies blood to the whole body, that head, neck, arms, all the vital organs in the, in the abdomen, as well as the legs.

Host: So, obviously a very important artery. So, when we talk about aortic disease itself, what exactly is that?

Dr. Newton: So, it's an umbrella term. It covers all the conditions that affect the aorta. And so that includes aneurysms, which is a ballooning out of the wall. Also includes dissections, which are tears or partial tears in the aortic wall and blockages just like any, the coronary arteries in the heart can get blocked and give you a heart attack or the arteries in the legs can get blocked and cause pain. You can get blockages in the aorta as well.

Host: Got it. I've also heard of atherosclerosis before. What is that?

Dr. Newton: So, that's the hardening of the arteries. And it's a process that involves kind of build up of cholesterol in the wall. And plaque forms or a hard blockage in the wall that can limit blood flow. Atherosclerosis can also be associated with aneurysms too. It is a little bit confusing. But primarily what people are referring to is that process of a blockage building up.

Host: Okay. And is it related to aortic diseases as well? Meaning could you get that buildup of cholesterol in the aorta?

Dr. Newton: Yeah, sure. Definitely. And it can cause some unique problems in the aorta as well, that are more rare, but in, within the sort of scope of aortic disease in general.

Host: So, let's talk more at a high level around how you diagnose aortic disease.

Dr. Newton: Yeah. So, most commonly it's found by accident, actually. So, you're doing a scan or an ultrasound for some other reason, you get a scan of your abdomen for abdominal pain, or an echocardiogram to look at your heart for heart checkup. And that's sort of a, you know, a lucky find you see this problem that needs to be fixed before it causes something serious.

There is the sort of unique situation of an abdominal aortic aneurysm. That's unique because we actually do proactive screening for that. So, folks that are over 65, who smoke or previously have been smokers, should get like a one-time ultrasound done. It's usually part of the welcome to Medicare package around age 65 to look for an abdominal aortic aneurysm.

Also folks that have a history of aortic aneurysms should get checked. And then there are some sort of genetic disorders that that make you more prone to it as well. That's a very sort of specific group of folks that would, their doctors are going to be all over it as well. So, then and less common circumstances, sudden pain can be a sign of an aortic problem.

So, a sudden tearing chest or back pain can be a sign of aortic dissection, it's a tear in the aortic wall. The pain is, comes along with that and it just feels like tearing. And that's the kind of thing that you, it'd be hard to ignore and most people, come to the emergency room for that very quickly.

Host: And, you know, you mentioned some things already, but at a very high level, I wanted to ask what exactly causes aortic disease.

Dr. Newton: Yeah. So, it depends a little bit which, sort of disorder we're referring to, but the basics are high blood pressure can cause dilation of the aorta, stretching it out. Smoking is another big one. It weakens the aortic wall and can cause dilation and put you at risk for things like aortic dissection and, and sort of the, our, all of our diets could be better. That, that kind of high-fat Western diet can also be a contributing factor as well. It's really, prevention is just a general healthy living, taking care of yourself, going to the doctor for checkups, making sure your blood pressure is reasonably controlled and you're taking your medications and not smoking.

Host: Okay. So just really leading a healthy lifestyle, don't smoke, healthy diet. Things of that nature are really the keys to preventing any sort of aortic disease. Is that correct?

Dr. Newton: That's right.

Host: And we've talked about a ballooning or enlargement of the aorta. How do you go about preventing that?

Dr. Newton: So, in patients that have aneurysms already, we don't necessarily fix them right away. You want to fix them when the risk of rupture, that's really the problem we're trying to prevent, when the risk of rupture is higher than the risk of a repair. So, in order to prevent an aortic aneurysm from getting big enough that it needs to get fixed, really good blood pressure control is important and again not smoking. And then regular checkouts. So, you want to keep an eye on how big it is and get it fixed before it ruptures.

Host: And when you say regular checkups, what exactly does that mean? Is that just like your annual visit with your primary care physician? Or is there something that is more specialized that you need to do?

Dr. Newton: Oh, that's a great question. So, it really it really is more specialized. These problems need to be followed by someone that is very familiar with aortic diseases. It's usually either a cardiothoracic surgeon or a vascular surgeon and some cardiologists as well. But you need to keep an eye on it either with an echocardiogram depending on where exactly the problem is. Echocardiogram or a CT scan or an ultrasound of the aorta in the abdomen. And the longest timeframe that I think is that you can go without getting it checked, if you have one of these problems, is really a year. And it may be even shorter if your aneurysm is growing or it's already, fairly large.

Host: When we were talking about diagnosis, you were talking about people over the ages or over the age of 65. And typically they kind of have that welcome to Medicare screening or ultrasound rather, you know, I'm 40 years old. Does aortic disease affect people my age or younger?

Dr. Newton: It's rare, but it does happen. It's primarily from genetic diseases that things like Marfan syndrome or Ehlers-Danlos, vascular Ehlers-Danlos they're, again, overall quite rare. And typically the patients have a other physical features that will clue doctors into those sorts of things. So they don't tend to get missed. But you know, occasionally it does happen. The other thing that can happen in younger folks is an aortic dissection or tear. Typically that's going to happen in people with very high blood pressure or some other trauma or some other very acute kind of thing. So, it is rare but occasionally can happen.

Host: Okay. That's good to know. And I'm curious, what exactly does a patient do if they are diagnosed with an aortic disease?

Dr. Newton: Yeah. So, the follow up with an aortic specialist is very important. It's not something that you want to sort of forget about for five years because the aorta typically, it's going to get slowly larger or the section can slowly get worse unless someone's watching it. But they can be monitored safely for a while, and it's not until it gets to a certain size or a certain severity that we actually intervene. And the idea is to prevents complications or even deaths from rupture or blood flow problems. It's to brush aside these visits, but they're really important.

So that's the number one thing to do, if you get an aortic disease diagnosis. The others are again, just healthy living. So, eating as well as you reasonably can, don't smoke and make sure your blood pressure is controlled. The folks that have these diseases should maybe get a blood pressure cuff and monitor at home, check once a day or maybe even twice a day while you're making changes to your regimen and just make sure that the blood pressure is where it needs to be.

Host: Understood and talking specifically about the aortic aneurysm, is that something that's treatable or curable?

Dr. Newton: Yeah, it's very treatable. So, depending on where the aneurysm is, there are different ways to fix it. So, aneurysms close to the heart typically require an open repair, open heart surgery, if you will, to replace that section with a new, new piping and in aneurysms that are a little bit further from the heart, we can start to use stents and that's a great minimally invasive way to seal off aneurysm or dissection and prevent it from getting larger. And it's a much quicker recovery than the older style open procedure. And it's done through usually some very small incisions at the groin in the femoral arteries.

Host: Okay. And just more broadly, what are the treatments available for aortic disease?

Dr. Newton: So, medical management is sort of the first, right? Just keeping an eye on things, getting the blood pressure down, improving their lifestyle and keeping eyes on things and for a good chunk of patients, that's all they're ever going to need. If the aneurysm or dissection gets to the point where it needs repair then surgery is kind of the only option.

Host: So, speaking of surgery, what happens after surgery? Like how fast is the recovery time and what can a patient expect?

Dr. Newton: Yeah. So there's sort of, there's two different pathways. There's the open-heart surgery folks. In that kind of situation, you're going to be going to the ICU afterwards typically a couple of days in the ICU. And then a couple more days outside of the ICU. And then afterwards, there's going to be certainly some pain, but typically, within a month or two, you're kind of getting back to your regular, a regular life.

For folks that are able to get the endovascular repair, you know, that stent repair, recovery is a lot faster. So typically, it's going to be about a day or two in the hospital. And then within a couple of weeks, folks are feeling well enough to get back to work.

Host: Yeah. Okay. And just for patients that are living with aortic disease, and you talked about a number of ways that it's medically managed; what is that like, how does a patient actually live with aortic disease?

Dr. Newton: Yeah. So, the good news is that with careful follow-up, people do very well, and it's not necessarily something that's going to affect your life in some huge way. The kind of only limitation that we really put on people is that if they have one of these problems, usually we ask them to avoid heavy lifting.

So, we know that very heavy lifting increases the blood pressure, even temporarily and can lead to problems further down the line. But otherwise, aerobic activity, all that kind of stuff is good. And we encourage it. Bending, gardening, there's no other sort of specific restrictions. The after surgery, it's also important to continue to follow up with your aortic specialist because usually other parts of the aorta need to be watched or your repair needs to be watched to make sure it doesn't develop any problems down the line. And with that careful follow up, any of these rare problems that can pop up can usually be dealt with fairly easily.

Host: Okay. Understood. Well, Dr. Newton, really appreciate your time today. Is there anything else that you would like to leave our audience with, with regards to the aorta before we close here today?

Dr. Newton: Yeah. I mean, I think it's something that is very treatable if it's found and followed up on, and the kind of the biggest, the thing that upsets me the most, I think is when we see a patient that has a very problem that can be watched or treated later on, but then we lose them to followup and we don't see them back until it becomes an emergency.

So really, I just want to encourage people with this diagnosis to make sure they're following up. That's the most important thing.

Host: Yeah, totally makes sense. Well, Dr. Newton, Thank you so much for your time.

Dr. Newton: Thank you.

Host: You've been listening to Dr. Daniel Newton VCU Health Pauley Heart Center Vascular surgeon. To learn more about coronary artery disease, or other heart disease items, visit VCUhealth.org/heart. To schedule an appointment call 804-628-4327. You can also check out our website at vcuhealth.org/heart. Follow us on Facebook, Twitter, and Instagram with the username handle VCU Health Heart. And if you found this podcast helpful, please check out our entire library from VCU health at VCU health.org/podcasts. Thanks for checking out this episode of Healthy with VCU Health. My name is Prakash Chandran, and we'll talk next time.