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Silent Threats: How Peripheral Aneurysms Develop and Are Treated · Flourish- A Prisma Health Podcast

• 0:04
  Caitlin Whyte (Host): This is flourish.
• 0:05
  I'm Caitlin White.
• 0:07
  With me is Dr.
• 0:08
  Joseph Bloss, a vascular surgeon from Prisma Health.
• 0:12
  Today we will dive into peripheral aneurysms, how they develop
• 0:16
  and how they are treated.
• 0:18
  Well, doctor, welcome to the show.
• 0:20
  My first question for you is, can aneurysms occur in
• 0:24
  places other than the brain?
• 0:26
  Dr. Joseph Blas:
• 0:26
  Yeah, so that's a very good opening question.
• 0:28
  the reality is that people hear aneurysms and they automatically
• 0:33
  think brain or aorta.
• 0:35
  But what they don't realize is that these aneurysms can actually develop
• 0:38
  quite, frequently in the arms and legs.
• 0:41
  And when they declare themselves, oftentimes it's an emergency.
• 0:44
  So it's less well-known, but not less dangerous.
• 0:48
  Caitlin Whyte (Host): And what does peripheral aneurysm mean?
• 0:51
  Dr. Joseph Blas:
• 0:51
  A peripheral is an overarching term that, delineates anything
• 0:55
  That is outside the central system like the brain And the aorta.
• 0:59
  It starts, mostly in the iliacs and can go into any other part of the appendage,
• 1:04
  so your arms or your legs, and that's what we would call peripheral artery aneurysms.
• 1:09
  Caitlin Whyte (Host): Gotcha.
• 1:09
  Thank you for that.
• 1:10
  Well, on that note, where in the body are these aneurysms
• 1:13
  more likely to develop and why?
• 1:16
  Dr. Joseph Blas:
• 1:16
  think it's worth noting that in order to understand a little
• 1:19
  bit of this pathophysiology, you gotta understand what aneurysm
• 1:21
  is.
• 1:22
  And so an aneurysm In just a plain language, description is a
• 1:25
  localized dilation of an artery.
• 1:27
  These things can occur in any one of your four extremities, behind your
• 1:32
  knees those called the popliteal artery, in your groins, Those are called the.
• 1:37
  common femoral, the superficial femoral, or the profunda femoral,
• 1:41
  the deep femoral artery in the arms.
• 1:44
  It can be an axillary or a subclavian artery aneurysm, or
• 1:48
  even further down the arm where the artery becomes, a little smaller.
• 1:53
  We call that the brachial artery, And so they can occur there as well.
• 1:56
  Caitlin Whyte (Host): Well, let's also talk about who is most at-risk for
• 1:59
  developing these peripheral aneurysms.
• 2:01
  Are there any health conditions lifestyle factors involved?
• 2:05
  Dr. Joseph Blas:
• 2:05
  Yeah.
• 2:05
  Actually, one of the ways that we can uncover these aneurysms is by a vigorous
• 2:10
  screening program, and part of That is knowing who's at-risk for these aneurysms.
• 2:15
  And we have very well-defined high-risk groups for people with
• 2:19
  aneurysmal disease, such as older men.
• 2:23
  Anyone with a smoking history or tobacco use at all.
• 2:27
  people with an established history of atherosclerosis.
• 2:31
  And in layman's term we call that hardening of the arteries.
• 2:34
  If you have an aneurysm in one area of your body, it is very likely that
• 2:39
  you have a higher propensity for an aneurysm in another part of your
• 2:42
  arteries or another area of your body.
• 2:45
  And so we would screen those people accordingly.
• 2:47
  And then there are some.
• 2:48
  More unusual type of aneurysms that occur because of previous interventions,
• 2:53
  like, vascular type interventions like a, an arteriogram or somebody who
• 2:59
  had an, a heart cath, a cardiac cath that went through the artery wall.
• 3:03
  those kinds of aneurysms, we would call pseudo aneurysms.
• 3:07
  but Those are also, you know, aneurysms that we would need to pay attention to.
• 3:12
  Caitlin Whyte (Host): Great.
• 3:12
  Well, you mentioned screening is important when it comes to.
• 3:16
  Uncovering these aneurysms, but how otherwise are they diagnosed?
• 3:20
  Are there symptoms that people should watch out for?
• 3:23
  Dr. Joseph Blas:
• 3:23
  really the overarching theme is that the diagnosis aneurysms
• 3:27
  is pretty straightforward.
• 3:28
  The challenge, however, is thinking to look for them.
• 3:31
  these aneurysms don't cause symptoms unless they have already become
• 3:37
  complicated, meaning they have caused, one of the complications
• 3:41
  of an aneurysm that we know exist.
• 3:44
  I can certainly go through that list if that might be helpful.
• 3:47
  Caitlin Whyte (Host): sure.
• 3:47
  I'd love to hear a few.
• 3:49
  Dr. Joseph Blas:
• 3:49
  Yeah.
• 3:49
  So aneurysms behave in a relatively predictable pattern, Aneurysms grow,
• 3:56
  And within that growth, the aneurysm can do usually one of four things.
• 4:01
  an aneurysm can grow to the point where the wall of the aneurysm
• 4:04
  becomes thin and can rupture.
• 4:08
  So, it can have a break in the integrity of the wall, And then the blood That is
• 4:11
  usually housed within the artery can exit the artery into the surrounding tissues.
• 4:17
  And that can be not only a limb threatening problem as in the, case of
• 4:20
  peripheral artery aneurysms, but it can be a life-threatening problem, obviously
• 4:24
  with the blood loss entailed in that.
• 4:27
  A second thing an aneurysm can do is that it can embolize and embolize
• 4:32
  is a, term that we use for when.
• 4:36
  Something inside the artery breaks off and travels and lodges in a distal part
• 4:43
  or a further downstream part of the artery, and it may block blood flow to a
• 4:49
  critical organ or to the foot or the hand.
• 4:54
  And the reason that that happens is because as the aneurysm grows, clot on
• 4:59
  the inside of the aneurysm builds up.
• 5:03
  And with every heartbeat, your body is exerting pressure, a shearing
• 5:08
  pressure that may cause the clot that's building up inside the aneurysm
• 5:13
  to break off and go downstream.
• 5:16
  A third thing is that it can compress other structures, and if aneurysms
• 5:23
  get large, This is a particular risk in the popliteal artery aneurysms.
• 5:29
  If aneurysms get large enough, they can.
• 5:31
  Take up space and things that lie adjacent to arteries are
• 5:37
  found everywhere in the body.
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  And those two things are namely veins and nerves.
• 5:43
  And so if an aneurysm, say for instance, the popliteal artery
• 5:47
  were to get large enough, it could compress the vein and cause a deep
• 5:51
  vein clot or thrombosis, or it could compress the nerve and cause symptoms
• 5:58
  associated with nerve compression.
• 6:01
  Paresthesias, numbness, neuropathy, And that sort of thing.
• 6:06
  And then there are more unusual behavior patterns, but well
• 6:10
  documented where they can fistulized.
• 6:14
  And fistulized is a term that we use to denote a communication between two
• 6:19
  structures that isn't normally there.
• 6:23
  So you can think of it as a more controlled rupture, if you will.
• 6:26
  It ruptured into an adjacent organ or into adjacent vein, And that connection
• 6:33
  can cause symptoms of swelling, as in the case of a vein or organ failure as
• 6:39
  in the case of rupturing and fistulizing Those are in general the, behavior
• 6:45
  patterns for these aneurysms And the aneurysms behave in one of these manners.
• 6:50
  Sometimes they have the ability to behave in more than one of these manners,
• 6:55
  depending on the location of the aneurysm.
• 6:57
  In the peripheral sy.
• 6:59
  the other behavior pattern that an aneurysm can have is called thrombosis.
• 7:04
  And that basically means that the amount of clot inside the aneurysm
• 7:08
  has grown to the degree that it can shut off that artery, acutely
• 7:16
  thrombosis, denotes acute cessation of blood flow through that artery.
• 7:22
  Usually from blood clot.
• 7:24
  And when that happens, obviously the organ on the other side of that aneurysm of that
• 7:29
  artery, has only a limited amount of time before it will start to have irreversible
• 7:36
  signs of, ischemia or lack of blood flow.
• 7:41
  Caitlin Whyte (Host): What treatment options exist for these aneurysms located
• 7:45
  outside of the head, and how are they different from brain aneurysm treatments?
• 7:50
  Dr. Joseph Blas:
• 7:50
  there's not a one-size-fits-all remedy for these aneurysms.
• 7:55
  there's a lot of decision-making that goes into how we fix them now.
• 8:01
  With technology and as the field has progressed, we have gotten many more tools
• 8:07
  at our disposal to treat these aneurysms.
• 8:10
  We can do something as simply as observing an aneurysm that
• 8:14
  management strategy is done for aneurysms that are too small to fix.
• 8:20
  There's still an aneurysm.
• 8:22
  They have not gotten to the size yet where we would be concerned based on
• 8:27
  histotripsy literature that they would rupture or they don't have clot inside
• 8:33
  them or previous evidence of it being, embolic in nature that we can reasonably
• 8:41
  survey or observe those aneurysms.
• 8:45
  Another mode of treatment is the open surgical arm.
• 8:48
  That's where we actually do bonafide surgery.
• 8:50
  So we actually open the skin, we go find these aneurysms and to fix it, we can
• 8:56
  do either what, what what's called an interposition graft, which means that we
• 9:01
  open the aneurysm And we typically do a bypass right in the line of the aneurysm.
• 9:08
  Or we can do a bypass around the aneurysm And then tie off the
• 9:13
  aneurysm above and below to prevent one of those complications that
• 9:17
  we listed earlier from happening.
• 9:19
  And a much more common way of treating aneurysms nowadays
• 9:25
  is the endovascular strategy.
• 9:28
  So endovascular denotes the ability to treat a pathology, anything
• 9:33
  including aneurysms, endovascularly.
• 9:37
  So from within the vascular system, that's what that word means.
• 9:42
  And to do that in the.
• 9:45
  cases for aneurysms, we typically use covered stents.
• 9:51
  So stents are devices that we place into the vascular system, and they are
• 9:58
  covered around a stainless steel or some sort of metal scaffold to exclude
• 10:06
  the aneurysm So, it prevents the blood from exerting continuous pressure.
• 10:12
  on the aneurysm wall to prevent it from growing, or it can cover the clot
• 10:17
  that's inside the aneurysm to prevent it from embolizing and going downstream.
• 10:24
  Most aneurysms are treated endovascularly now, but there are still bonafide
• 10:30
  situations where, open surgical repair remains the gold standard.
• 10:37
  Caitlin Whyte (Host): Well, what are some of the risks of leaving
• 10:39
  a peripheral aneurysm untreated?
• 10:42
  Dr. Joseph Blas:
• 10:42
  Yeah, again, these are silent
• 10:44
  most of the time, And so when they do cause symptoms, it's because they
• 10:48
  have gone down and, behaved in one of those manners that we listed earlier.
• 10:54
  And so the symptoms that someone would have if these aneurysms were to become
• 11:00
  complicated, any cause complications.
• 11:04
  Would be obviously a high-risk of mortality if they bled into a
• 11:09
  surrounding space And we weren't able to address it quickly.
• 11:13
  you could get what's called acute limb ischemia, which is a sudden, cessation of
• 11:20
  blood flow to a given organ or appendage that would cause an increased risk
• 11:26
  for amputation if we weren't able to.
• 11:29
  Overcome that situation within a relatively, timely fashion.
• 11:34
  so limb loss, amputation life loss from the, blood loss.
• 11:38
  Those would be the, the big ones.
• 11:40
  Caitlin Whyte (Host): Gotcha.
• 11:41
  Thank you.
• 11:42
  Well, you touched on this a bit earlier, but I just wanna come back to it.
• 11:45
  If someone has a peripheral aneurysm and they have it treated, does
• 11:49
  that still increase their chances of developing another one later?
• 11:53
  Possibly.
• 11:53
  Mm-hmm.
• 11:54
  Dr. Joseph Blas:
• 11:54
  Yes.
• 11:55
  by and large, anyone who has had an aneurysm should undergo surveillance
• 11:59
  for the aneurysm that they have, if they've had a repair of that aneurysm.
• 12:05
  They should undergo surveillance of the repair of the aneurysm that they have,
• 12:10
  and if they have an aneurysm That is either repaired or under surveillance,
• 12:14
  they should be screened for other aneurysms elsewhere in the body.
• 12:19
  Caitlin Whyte (Host): All right, and my last question today, doctor, are
• 12:21
  there steps that people can take to reduce their risk or even prevent
• 12:25
  peripheral aneurysms from forming?
• 12:28
  Dr. Joseph Blas:
• 12:28
  The big thing is to modify your risk factor profile.
• 12:32
  So as these aneurysms are associated with age smoking, atherosclerosis,
• 12:40
  known aneurysms elsewhere.
• 12:43
  By controlling some of the lifestyle things that can cause
• 12:47
  aneurysms, like smoking And the development of atherosclerosis.
• 12:53
  That's usually a part of having high blood pressure, high
• 12:58
  cholesterol, diabetes, renal failure.
• 13:02
  Those are the biggest opportunities to decrease the chance of
• 13:06
  you forming these aneurysm.
• 13:10
  Caitlin Whyte (Host): That was Dr.
• 13:11
  Joseph Bloss.
• 13:13
  For more information, go to prisma health.org/flourish.
• 13:17
  If you enjoyed this podcast, please share it on your social channels and
• 13:21
  check out the entire podcast library.
• 13:23
  For topics of interest to you, I'm Kaitlyn White and This is Flourish.
• 13:28
  Thanks for listening.