Abdominal aortic aneurysm causes, symptoms and treatments (2023)

The following is a paid program from UChicago Medicine.

Abdominal aortic aneurysms are more common than most people think. Essentially, it is an enlargement of the aorta in the abdominal region. Now, sometimes the aorta can burst, which can be fatal. Jim Craig, goalie for the 1980 USA Hockey Gold Team, will be on the show to discuss the condition that claimed his father's life.

We will also have one of the greatest specialists in the treatment of abdominal aortic aneurysms, this is Dr. Ross Miller. He is director of the Center for Aortic Disease at UChicago Medicine. We will answer your questions and answer as much as possible in the program. This is coming to At the Forefront Live.

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Now today on At the Forefront Live we have Dr. Ross Milner, director of the Center for Aortic Disease here at UChicago Medicine. And Jim Craig is with us. Welcome to both.

And a quick reminder for our viewers, this program is not designed to replace a visit to your healthcare professional. But we also want to remind people to write their questions in the comments section. In the next half hour we will get as far as possible. Welcome to both gentlemen. I appreciate you being here.

Thanks.

Yes, I'm looking forward to it.

Jim, I want to start with you because we don't often have a hockey goaltender on the show. In fact, you will be the first. And I guess the question would be, why is this so important to you and why are you here today?

Well, my dad died of a ruptured aneurysm, and it was because he didn't really notice. I was lucky enough to work with W L Gore on the Ultimate SAAVE campaign. And so I've been traveling the country for the past 12 years helping to raise awareness and save a ton of lives. So today I'm really, really excited to be back here with Dr. Milner to help all viewers understand the importance of getting tested.

And Dr. Milner, let's talk a little about... first give a definition so we know what an abdominal aortic aneurysm really is. If you can tell us what it is, and we'll go from there.

Thank you very much. So, an abdominal aortic aneurysm is an enlargement of the normal blood vessel that runs through the abdomen, supplying many of the important organs. And when it gets too big or too thin, it's like a balloon that starts small and grows bigger. And when it gets too big it can explode. And when it does, it can be a life-threatening event. We'd like to identify people, as Jim said, before that happens so we can treat him so the aneurysm doesn't rupture.

And what strikes me, we were talking a little bit before the show, and it really hit home with me, is that this is more common than people think.

It is much more common than people think. And one of the things that Jim has done so well with his advocacy is getting people to think about it. And for men of a certain age, and if you have a family history and you're a smoker or have a history of high blood pressure, you're at risk of getting this disease. And it's very easy to check, and there's no risk with the assessment that can be done. And it can be detected more often and is a common problem that is not checked often enough.

And Jim, this is your passion. It is. Really important to you, and it obviously started with your dad. But you've worked for years to try and raise awareness. Tell us a little bit about what you've been doing and what people should know in terms of detection.

Well, as Dr. Milner, is the silent killer. You have no symptoms. And really awareness must be the most important thing. And now I'm married, I have two kids. And my father, my mother, could never see them, and it was only because of conscience.

And then when I was lucky enough to be part of the Ultimate SAAVE campaign and work with Gore, we've found ways over the last 12 years to reach different communities. And today Facebook Live is an amazing way to do just that. But my father also had perfect symptoms. He had high blood pressure, was a smoker, suffered a massive heart attack at age 45. But as he gets older, you need someone to be an advocate. So people need to listen and understand how they can help.

And in my case, my father went to the wrong hospital, he went to a small hospital. I didn't even have a vascular surgeon. And he died. And today with all the knowledge we have, that probably wouldn't happen. And the big part of all this work was that my brother Don had an aneurysm. We checked and they took care of it. So there is a family member. And as said by Dr. Milner, it's not just whether you're a smoker, it's also a family history. So it behooves viewers today to pay attention to who they know was in their family who may have died of a ruptured aneurysm.

At that time, Dr. Milner, you must have thought I had a heart attack, right? So I don't think the breakouts are accurate. I think there's even more to it than we know.

Well Jim, you also said before the show, which again I thought was interesting, you were talking about your father. And he mentioned that one of the symptoms he had, he thought he had kidney stones. Then describe what was happening in terms of symptoms. What was he complaining about?

What I've learned from working with all these great doctors over the years is that my dad had a broken can so it was giving false signals. So he went where he felt comfortable. And we didn't know any better. We weren't smart enough, we weren't educated like you will be today after this show. So we took him to where he was comfortable, which was a much smaller hospital. And since there was no vascular surgeon there, there was probably no way to save lives.

And the advances in medicine and with these endovascular products that are coming out, especially working with Gore and learning and how to use them. doctor Milner, it's really amazing how this has changed since my dad had an open procedure for what you're doing today.

And Dr. Milner, tell us a little about the symptoms of an abdominal aortic aneurysm. Because there are things that people can know. First, with whom is this most likely to happen? We understand you're talking about smoking and there are a few things to look out for. But who is more likely to have it? So what would the symptoms be?

Clear. Jim, as we mentioned a little bit, men. They are much more common in men than in women. Men over 65 years old. people who smoke People who have a family history. And people who have high blood pressure are at the greatest risk.

As Jim said, most of them have no symptoms. People feel good, they don't even know they have the problem. And when we're really concerned is when people have symptoms, because that could be a sign of a ruptured aneurysm. And those symptoms would be abdominal pain or back pain. Or even more disturbing sometimes, someone passes out at home and no one knows why. And you don't see them right away, and that's because they've lost a lot of blood from a ruptured aneurysm. And they could still be saved if they got to the hospital. But stomachache, backache and someone faints.

And when we talk about abdominal aortic aneurysm, which, again, I think people need to know and educate themselves, when they think of the aorta, I think most of us think of the heart. Actually, it doesn't happen in the heart, right?

So it is. In fact, one of the things I'm always asked is what does a vascular surgeon do? And most people think I'm a heart surgeon. And no offense to heart surgeons, but I'm a vascular surgeon. So the difference is that an abdominal aneurysm is in the stomach. There are aneurysms that can occur all over the body, but this is especially true when we are talking about a triple A, or abdominal aortic aneurysm, located in the lower part of the abdomen. Close to your belly button to give you an idea of ​​where it would be. And aneurysms can appear higher up, closer to the heart. But specifically, we are talking about an aneurysm in an inferior position.

So, Jim, I need to talk a little bit about… because I would be remiss and I'm sure I would get a lot of angry Facebook notes… I need to talk a little bit about your background. Because I remember 1980, I remember it well, watching your team. It was the miracle on ice. it was a miracle. Take us back to those days, and here you are today supporting it. So it was a big change for you.

Yes. Sometimes in life you have a platform and you can use it to do good things. And when I met Dr. Milner, I knew we had a kindred spirit and that one day we would do something together that would be truly beneficial. What I loved most about being on this team was that we discovered how to be part of something bigger than ourselves. And this cause today is much bigger than me. I always tell people I want to live long enough to see my children's children. And I just had my first granddaughter.

Hello.

And that's what if you know and you've been tested and found, these doctors' success rate is 98%. This is amazing. You go to the hospital and are in and out in one day. You have that constant attention, you have the right hospitals, they can monitor you, the product is great. And to see someone suffer a tragedy like the one I had with my dad because people just don't know is not good enough.

So our team, the biggest thing I liked about our coach is that he drove the changes. He discovered a way to win that no one had thought of before. And I think that's exactly what they're doing today with this Facebook Live. It's just an amazing tool for awareness.

doctor Milner, I'm curious, you're the director of the Aorta Disease Center. So you do this work all the time. And that's important when you want that kind of treatment. And he mentioned that sometimes there's an issue where someone might go to the wrong place. And I don't want to make a shameless plug out of this, but it is, and I'm going in that direction, but that's an area of ​​expertise for you and the center. And why is it so important?

Yes, this is an area of ​​expertise for us, as you said. One of the aspects is something Jim was talking about. We have a great team. We have a great team of doctors. We have a wonderful team of nurses in the OR. We have an excellent team of nurses in our clinic. We have anesthesiologists, we have doctors and ICU nurses on the floor. We have a great team of people who can take care of patients.

And I think one of the things that we're very proud of is that we've been consistently recognized here for the excellent service that we provide and for being high performers. Because abdominal aortic aneurysm repair is nationally reviewed and rated for the quality of care it provides, and we are a high-performance center with very high volume. And it's something we're very proud of because we try to take very good care of patients, but we do it as a team. And even though I have the title of director, I have an incredible team of people working with me who provide exceptional care for people and save people who might not otherwise have a chance.

We hear a lot about detection and how important it is. What do you do when you find someone who has one of those things that... do you work on it right away or what?

So it depends on the size. Some are more disturbing than others, obviously. The older you are, the more urgent it is to seek care. Usually our first step is the ultrasound, as Jim mentioned with the Ultimate SAAVE Act. The next step is a CT scan so we can determine how the repair can be done and then make sure it is safe for them to go in for surgery. And sometimes it's within the day if it's really a problem, or even within a few hours or immediately. And sometimes they are repaired selectively by size. But we really take the next step in our decision based on what the CT scan looks like.

And Jim, we were talking about ultrasound before we started the program here. And it's so easy, I'm not saying it's easy to do an ultrasound, but it's easy for the patient. Very non-invasive procedure, very easy on the patient and lifesaving.

Yes and they tested me and I'm always kidding. I mean, it's a little jelly in your belly. It is so easy. And what happens is most people that people meet, as Dr. Miller, it's by accident. They've been in the hospital, they've had pneumonia, they've had an x-ray, someone noticed. So for all primary care physicians, it's really in your community. And the community is what really matters. That's what we're here for, to really take care of each other and be a little bit kinder today. You do not need to look for yourself who may have an aneurysm, you have the opportunity to look at any loved one, friend or any other person and inform them about it.

And the ultrasound part is, Dr. Milner, when you know a patient has an aneurysm, you meet with representatives of the company you're going to use. You sit there, study, work together. It is a very well planned operation and the results are amazing.

But when you're done, he's a-- I don't want to use the word-- but he's no good. And the results are usually not very good. And even if you save them, that person doesn't look the same. So the awareness part is incredibly important.

Yes, and one of the points since we've talked about this earlier, which I think is really important, is not just that the ultrasound is technically easy to do, because it's relatively easy, it's a completely safe test. There is no risk for ultrasound. So when you're looking for a preventive exam for control, there's no risk of an ultrasound. And you can, and it's easy to tell right away if it's something to be concerned about and investigate further with absolutely zero risk.

And then you find the aneurysm, and we were also talking about stents before the show. Then explain how it works. And I think, again, most people when they think of a stent, they think of something a little bit different than what they think of.

Yes. We can now repair many aneurysms with a less invasive approach. As Jim mentioned, many of our patients go home the next day. And it's a process done by the inguinal arteries, the femoral arteries. Often with tiny, tiny cuts, even if you don't even see it, that we can use to get to the devices inside. Which is a dramatic change from the typical major surgeries, which he took a long time to recover from. And although it is a very good surgery, it takes a long time to recover from it. And with the stent approach it's much better.

Stents used to repair aneurysms, most people think of stents placed in the heart, which are small stents, about two or three millimeters in size, and it's just pure metal that holds the heart open. As these stents are, they are much larger, almost 10 times the size of the stents placed in the heart. And they have tissue around them, so all the flow goes through the stent and away from the aneurysm. And so what we see over time is that the aneurysm will ideally shrink.

Super. So we get questions from our viewers. I want us to achieve as much as possible. One that just came up is, can you explain the kind of pain you would feel in your stomach? So again, back to the symptoms.

Do you want to... no, I'm just kidding. I'll do it.

I know, absolutely.

So the type of pain, the way I tell my patients, a lot of people we know have chronic back pain. And sometimes an aneurysm is discovered because someone has chronic back pain and is evaluated. It's the worst pain you've ever felt in your life. It's unbearable pain. Whether it's back pain or abdominal pain, if you have a pain that won't go away and it's a really bad pain, you need to take care of it right away. Even if you don't know you have an aneurysm, if you have this type of pain, you should be evaluated as soon as possible.

This is important. A few more questions. When do you place the stent? She asks us, my husband has a 4.9 aneurysm and my doctor says to keep seeing him. I'm not exactly sure what they mean. I think it's the size, correct?

Yes. In general, and I don't want to generalize, it would be unfair to ask just one question, but the standard recommendations are when an aneurysm is about 5.5 centimeters in size, so when we look at the risk of surgery versus the risk of the aneurysm, that's when we say, yeah time to fix. Normally, we'd say a 4.9 is safe to watch. But that would be an individual decision made between each doctor and their patient.

And I've repaired a few aneurysms that size and I was concerned about the patient, their risk factors, or their symptoms. So I don't want to make a sweeping, sweeping statement. But usually 5.5 cm, because that's when the risk of the aneurysm starts to outweigh the risk of the surgery and we say yes, go ahead.

How dangerous is the operation?

So surgery, especially now with the inguinal stenting approach, is very low risk. Any invasive procedure has some risk. The overall risk of leaving the hospital or having serious problems is extremely low and certainly much lower than the year we did all open surgery.

There is a part, yes, however, repairing an aneurysm, whether male or female, makes a difference. Because women tend to have fewer options. Really good questions for patients to ask themselves are: How comfortable are you with an aneurysm? Want it fixed? And I know over the years of doing this, calm is also a big issue. But this is where you really need to work with your healthcare provider and choose what's most comfortable for you. And you do your research, right?

Yes absolutely.

And Jim, you've been tested. You mentioned that your brother was tested and saved. All your family members - are they gone?

All my family members have been told they need to be tested. Now I can honestly say that I don't know if everyone has it. But what's really interesting about my brother Don is that when I was working for Gore, the blessing I received was the knowledge of caring and looking for symptoms. And not only did I get the canvas from my brother Don, but from a number of friends you just found out that it looks like it was meant to be. And you ask them different questions, and they're more prepared when they go and get physical, and there's a certain age where that's a big part of it.

But when we first evaluated my brother Don, he didn't have an aneurysm but needed open-heart surgery. And years later, he was tested for an aneurysm, and he had one, and they followed him up. They took it off when taking it off. And now I'm happy to say that his life was saved thanks to the hard work and awareness that we all worked so hard to get to where we are today.

Another question from a viewer. His father died of an abdominal aortic aneurysm. He was a lifelong smoker. I am a non-smoker. Is the risk of an aortic problem greater because of your history? Or is this mostly caused by smoking?

So yes, aneurysms definitely run in families. It is not directly inherited. Just because Jim's dad had one obviously doesn't mean he's going to get it. And clearly it has been reviewed and not. But there is a greater danger in families. And actually one of the things I've been doing with my patients now. And I think, partly because I know Jim like I do, I say to all my patients, yes, I'll take care of you, but you should tell your family members that they need to be tested. Whether they are siblings or children, I tell them that when children reach 50 they should have an ultrasound at 50. And if everything is fine, then you don't have to check them for another 10 years. But if you have a family member, especially a woman in your family, who has an aneurysm, you should get her checked out even if you don't have the other risk factors, because family history alone is a risk factor. enough.

That's an interesting question from a viewer. Another viewer whose father died from it. Again, they don't smoke, but they also want to know what steps they can take to avoid it. Are there steps you can take?

Yes, unfortunately, aneurysms, once they occur, are difficult to prevent. Now, the way to avoid this is: you can't change your parents. You can't smoke and you can have your blood pressure well controlled and your cholesterol well controlled. And that's really the most you can do to prevent an aneurysm from forming. But the risk that just comes from genetics apparently doesn't go away. But the biggest modifiable risk factors are smoking, blood pressure control, and cholesterol control.

So you mentioned 10-year projections. Oh go ahead, sorry.

One thing I would like is for these viewers to say that their dad died because of this. But did your father have brothers? Anyone else in your family? Could they be aware? Are you going to come back, after this show, and tell everyone you know that they're in the family tree of what you're learning? Because that's how you help raise awareness.

And it's also a quick test.

Excellent point. Jim makes an excellent point. And it's an easy test.

The choice is not good, friends. When they identify one and know it, the in-and-out process has a 98% success rate. But we don't want to say what the success rate is when there is a break.

Well, Jim, you mentioned even before the show, we were talking and you said, people think about the cost of an audition or something like that. And you made a good point. And if it could reach our viewers, that would be great.

Yes, I'm using the example. It's like the cost of a good bottle of wine. Why risk your life because you didn't get a free screening? If you are at risk, go ahead and be proactive about seeing your primary care physician. If you are going to have a physical exam and you are over 50 and have any questions, ask and ask for help. Reach out to your community and find out what kind of rankings are available. There are always exams available from different churches or organizations that you can help with. And if not, be proactive and start one.

And Dr. Milner, is this something covered by insurance? this type of projection.

So in the Ultimate SAAVE Act that covers Medicare, there's an introduction to Medicare when you have the right risk factors. Otherwise, it's not something that is usually covered. But like Jim said, number one, there are a lot of places that offer free viewing. But number two, it's not a very expensive test that can save lives. So from my point of view, it's worth the cost. But as an introduction to Medicare, you can get it when you have the right risk factors.

So you recommend people aged 50, if they have risk factors, and 10 years later. So it's every decade? Or how...

So if you don't have an aneurysm between the ages of 50 and 60, the chance of developing an aneurysm later in life is very small. But again, since there's no danger with the ultrasound, I'd say check it every 10 years. You get to 70 and you're fine, so you can decide if you want to do this at 80. But we usually see patients in their 80s and 90s with high-risk aneurysms that are healthy and still active. and desire to do things. And it's worth reviewing.

Well, one of the things that surprised me the most about working with Gore is when I'd walk around, and you'd see in the old days when you had a vascular surgeon who did nothing but open up and he wasn't comfortable with this endovascular repair. So they would tell their patients, you're 80, you're fine. But now these new doctors have so much competition and the product is so good that they are treating people who are 92, 93 years old and have an incredible quality of life. So don't let anyone tell you that you can't solve it because of age, because you can and you should. And make sure you get out there and go to the right places to brag a little today because you deserve it, right?

Yes thanks.

One of the things I always like to talk about on the show is there are a couple of things, and one of them is the team approach that we have, and you've mentioned that before. What we do is very important. But the other thing that I think is a strength of this institution is the fact that it is a research institution. So let's talk a little bit about our clinical trial research, what kind of things are happening here that could, or anywhere, affect this situation.

Yeah, thanks for bringing that up, because I think one of the nice things about working in a place like this is that it's an educational institution. And as part of that, we did a lot of research. We are doing several clinical trials. I am involved nationally in leadership roles with several clinical trials. And locally, we're involved in a number of clinical trials here to look at the devices as well. We do a lot of research and publishing.

And actually, one of the points that Jim made earlier was about controlling women. And we have a paper that we published here in the last few months in one of our leading journals that shows that in a population study of ruptured aneurysms that was done, there was a much higher proportion of women than expected. And that maybe when we do the evaluation we look for factors to evaluate, but maybe we didn't look for all of them. I think the really fun part of what we do, other than patient care, is the academic part of what we do in a place like this. And I think we tried to do that really well.

And why I was so excited to come here is when I met Dr. Milner, I likened him to a coach. Some managers prepare very well for a game, and some managers are very good when the game starts. But very few of them are good at setting up and playing. And so his love for being an advocate for medicine is so evident. And he is a great mentor, teacher for young people.

But he's still very young in the profession, which is really cool. And he forces change within the hospital, and it just keeps getting better. And it's a pleasure to be able to be with you and learn because it gives me an opportunity when I'm with Gore to help and be more aware and more professional in the approach.

Thanks Jim.

So I'm curious, we've talked a lot about how much it affects men, and you mentioned women as well. And there was a case that you mentioned earlier, and obviously we're not going to go into the details, but it's important for women to know that too. But your symptoms might be a little different. Is this right?

Well, I think part of the problem is that it's a predominantly male disease that while the symptoms aren't different in women, again, as Jim mentioned earlier, people just don't think about it as often as they should. So the symptoms aren't drastically different, but the awareness of it is significantly different because everybody thinks, oh, it's an abdominal aneurysm. Only men have this disease. And that's not true.

And you don't want to go to an emergency room and be stuck when people don't know what might be going on. And this is very important to go to the right hospital and know that the people who are there, the professionals who are there, certainly know the risk factors and move much faster than if you don't go to the right place.

Here we go. We're out of time.

It was fun.

It went by fast, didn't it?

If he does.

That's all the time we get into the show. Thanks for being on the show. We really appreciate it.

Thanks for having us.

Yes, I think it's great.

I just think this is a cutting edge thing that we need to think more about and we're definitely going to get this out to the right people.

Perfect perfect.

I think we cover a good spectrum as well, which is good.

Absolutely. If you would like more information, please visit our website at UChicagoMedicine.org or call 888-824-0200. Also, remember to follow our Facebook page for more events and live streams. We have another one this week. Thanks for watching hope you have a great week.

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