Diagnosis & Treatment of a Complex Abdominal Aortic Aneurysm

This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Today our guest is Dr. Wang Teng, from Saddleback Memorial Medical Center, one of the few vascular surgeons in the nation trained to use the fenestrated endovascular stent graft and was the first to perform the surgery in Southern California in 2013. Welcome, Dr. Teng.

Wang Teng, MD: Welcome, Deborah. Thank you for having me.

Deborah Howell (Host): Oh, it's our pleasure. So a complex abdominal aortic aneurysm is referred to as the silent killer, since symptoms are often not present, and if it ruptures, it often leads to death. Today we're going to try to find out more about the causes and symptoms of a complex abdominal aortic aneurysm and how to treat it. Right off the top, what is a complex abdominal aortic aneurysm and how does it develop, doctor?

Wang Teng, MD: Thank you, Deborah. So an aortic aneurysm is a bulging of the main vessel in your body. The aortic carries blood from the heart to your legs and your other parts of the body. Normally, it measures about an inch in diameter, about two centimeters. But over time, an aorta can stretch and bulge and become aneurysmal, in which the wall of the aorta weakens and the aorta itself thins out, stretching to sizes greater than twice the diameter of normal aorta. And left alone, these can rupture and lead to death.

Deborah Howell (Host): Well, obviously we can't see it, can we, because it's inside our body.

Wang Teng, MD: That's right. It's right in front of the spine, the back portion of your abdominal cavity, and therefore diagnosis of these aneurysms requires some sort of imaging or a detailed examination.

Deborah Howell (Host): Can this ballooning be prevented?

Wang Teng, MD: This is a disease process that occurs silently. It's a degenerative process to your aorta, it’s as wrinkles develop or hardening of arteries develop, the inflammatory changes inside the aorta weaken it from smoking, diabetes, high blood pressure and such. And the aorta then weakens and becomes dilated.

Deborah Howell (Host): Okay. So you mentioned a few things we can do right off the top. To prevent it, don't smoke.

Wang Teng, MD: Correct.

Deborah Howell (Host): I'm sure fatty foods are a no-no.

Wang Teng, MD: Well, the biggest factor that contributes to aneurysms is really smoking. High blood pressure, diabetes, you know, the disease, the lifestyle factors that lead to degeneration of arteries, hardening of arteries, really. That's how you can prevent these.

Deborah Howell (Host): Okay. So how is this type of aneurysm different than other abdominal aortic aneurysms?

Wang Teng, MD: So the type of aneurysms that I take care of with our new technologies are what we refer to as complex, meaning that the aneurysm and its location makes it difficult to treat. And there are current technologies today in which devices, implants, are used to stent, to reline the aorta, which have a unique anatomic characteristics. Specifically, it's when the aneurysm originates really close to your branch arteries, specifically the kidney arteries. And that's how we refer to these as a complex aortic aneurysm.

Deborah Howell (Host): Okay. Now, what symptoms, if any, may individuals experience if they have an abdominal aortic aneurysm?

Wang Teng, MD: That's right. Oftentimes, these are quiet. And the symptoms that you'll feel, you may feel a pulsing feeling in your abdomen as you lay in bed or sitting quietly, similar to a heartbeat. You're actually feeling the pulsations of this dilated vessel. If you feel a severe, sudden pain in your abdomen or the lower back, this may represent that your aneurysm is about to burst. And if it does burst, you'll feel a sudden, intense weakness, dizziness, pain, and you may even lose consciousness. And this is a life-threatening situation. You need to call 911 immediately.

Deborah Howell (Host): What again area I know the lower back and like could you tell us physically again on the body where we might feel this?

Wang Teng, MD: Really behind the belly button about that level of your abdomen.

Deborah Howell (Host): Sharp pain or a pulsing?

Wang Teng, MD: Sharp pain pulsing throbbing feeling. Really those are what you want to watch for. And oftentimes when you do feel that, it's often too late.

Deborah Howell (Host): Say you do get to the hospital, how has it been detected?

Wang Teng, MD: So the vessel sits in the back of the abdominal cavity. So the best test to look for these aneurysms to see, well, if you have an aneurysm or if it's ruptured, is a CAT scan. And that CAT scan will image your blood vessels. It'll tell me where the aneurysm is, how big is it, and whether it's trying to rupture or not.

Deborah Howell (Host): I see. Okay. Now, if no symptoms are present, how is the aneurysm diagnosed then?

Wang Teng, MD: Really, we find these from scans for other reasons. Such as if you came into the emergency room for kidney stones or if you came in for abdominal pain for other reasons and a CAT scan is performed, the CAT scan looks at all the organs inside of your abdomen and the aorta is one of them. So oftentimes, these aneurysms are diagnosed when you are looking for other things in the abdomen, such as kidney stones, appendicitis, and such.

Deborah Howell (Host): And that's a lucky find.

Wang Teng, MD: And that's a lucky find. Thank you, doctor, for that!

Deborah Howell (Host): Yeah. Okay. What are the treatment options?

Wang Teng, MD: So I made mention earlier, we can put stents inside of these aortas. in which we reline them and we put these stents in through surgical incisions from the groins. So we go from the branch arteries below the aorta and we thread a wire under x-ray vision through the blood vessels, almost like tunneling through the blood vessels and laying a fabric-lined metal lattice, flexible stent and the aorta itself is relined and protected from rupturing.

Deborah Howell (Host): How long have we been doing this? I mean, when you were a little boy, were people thinking and talking about relining your aorta? It's kind of crazy, right?

Wang Teng, MD: Right. It is kind of crazy. This is the technology that we have today that really we're saving lives. So traditionally, the operation is an up and down incision in your abdominal cavity. You know, from the sternum to the to your pubic bone, and we open up the abdomen, and we surgically replace this weakened aorta with a fabric tube, and we sew it in place. It's still done today. However, with stent graft technologies, the traditional stent graft technology, which has been around for about 15 years now, to the second generation of stent grafts, which are these fenestrated stent grafts that we may mention earlier. That's been around for about two years now.

Deborah Howell (Host): And that's what I'd love to talk to you about now. Please explain to us the fenestrated endovascular stent graft procedure.

Wang Teng, MD: Cook Medical, we thank them for bringing this to the forefront of technology. They have the zenith fenestrated stent graft. And the word fenestrated means there's cutouts. So there's actually cutouts in the stent itself, which allows us to put the stent high up in the aorta, way above the aneurysm, and even above those branch arteries that come off. Those are the kidney arteries. And that allows us to treat a broader range of aneurysms, aneurysms that encroach on the kidney arteries or even go above the kidney arteries. And same thing, we place these through surgical incisions in the groin over wires using x-ray and iodine injections to position these stents. These stents have to be custom fitted to a patient's aorta anatomy. And so they need to be custom built with cutouts or fenestrations at the exact positions of where these branch arteries come off.

Deborah Howell (Host): Absolutely incredible. Now is this inserted through the groin for females and males?

Wang Teng, MD: That's correct.

Deborah Howell (Host): Okay. Okay. Do you have anything else we should know before we have at our day?

Wang Teng, MD: You bring up the women and men. So if women are diagnosed with aortic aneurysms, there's a strong chance that there's a familial component, means that it carries in their family. And oftentimes we'll see women who I diagnose with aneurysms, and you simply ask and they'll say, yeah, my mom or my aunt or my grandmother died suddenly, and they think they had a ruptured aneurysm. What's important for them is that their children be screened, females and their family need to be screened.

Deborah Howell (Host): Tell your kids your medical history.

Wang Teng, MD: Exactly.

Deborah Howell (Host): Put it in a file on their computer or wherever you need to put it to keep it safe and make sure they know it could save their lives.

Wang Teng, MD: Exactly. That's right.

Deborah Howell (Host): And where can people go to get more information, Dr. Teng?

Wang Teng, MD: Our organization, our Vascular Surgical Society, is called vascularweb.org, www. vascularweb.org. And there's a tab that has vascular health. It talks about different diagnoses of vascular disease. aortic aneurysms are one of them, and hardening of the arteries, carotid artery disease, vein disorders. You can find those online, and there's a wealth of information to the public.

Deborah Howell (Host): Well, thank you so much, Dr. Teng, for spending some time with us today and for all the life-saving work that you do. It's been great to have you on the program today.

Wang Teng, MD: It's been great, too, Deborah. Thank you so much.

Deborah Howell (Host): To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have a fantastic day.