The Importance of Screening and Monitoring with Aortic Disease

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Dr. Frank Caputo:

Screening and surveillance takes so many forms. We all have a story here in this room. You guys all sitting down definitely have a story and some of us personally have a story when it comes to aortic dissection, too. But we got to look at our family history. It's good to know our family history a little bit. I mean, just for anybody out there, can we identify anything that's happening? Did Grandpa or Grandma die suddenly? Should we identify these patients?

That's the whole idea behind genetics, forget the big panels or anything but something funky in our family. We're so close to realize that we identify colon cancer, we identify lung cancer, we identify other families. Hypertension, I don't even want to talk about that, but there's certain things we identify and we are so quick, but no one is quick to identify aortic problems or even other vessel problems. And that's part of it.

And the other part of it is during these emergencies, after we get you through these emergencies, one of my favorite times is when I talked to a patient at discharge and they said, "Thank you so much. I mean the difference in me." I go, "We're not done yet. Welcome to the Cleveland Clinic family aortic family. You're here forever."

And how many scans have I scanned on people? I know people in the audience. I know they get sick of me sometimes with the amount of ultrasounds and stuff, but we have to watch out for another emergency. We got to keep those complications down. We look at the aorta, we know that once an aorta is dissected, it's a diseased aorta, and we got to make sure no complications happen to that. So that's a whole new level of surveillance and screening. We screen your aorta, we screen its branches, we screen the carotid, we screen the arms, make sure no aneurysms form, make sure no dissections cause any malperfusion.

We want to make sure we keep you guys safe, right? That's why we do it. And we all talk. And that's what makes this place so special, is the ability to screen and surveil everyone as an individual. Patient centered care.

I know when you look at regular aneurysms, people may not even know this, but if you look at regular atherosclerotic aneurysms, if you smoke 10 cigarettes in a lifetime, you are at increased risk of having an aneurysm. So if you look at any of the US task force or the STS guidelines, any type of smoking history, and then advanced age and family history, for sure, we have to screen you guys. And that's as simple as an ultrasound sometimes.

Dr. Eric Roselli:

I think we treat the aorta better when we can do it electively, proactively, trying to anticipate what's going to come next. And that's what's probably changed in the way we think about it compared to the way it used to be. It used to be, "Oh, there's this problem. See if we can get this patient through this." And then when we're done, we're like, "Yep, we fixed it. See you later."

Now we're like, No, no. This is a disease that may affect your entire aorta. And we're doing pretty good at saving people's lives and we're doing pretty good at managing other things like their blood pressure and keeping them around for a long time. And so let's just sort of come to grips with the fact that this is a chronic condition and our goal is to keep you around as long as possible and maintain the quality of life that you have as best as possible. That might mean multiple trips to operating room throughout a lifetime. But if we think about it, sort of being proactive surgery, not rushing into anything, but certainly proactive surgery and planned surgeries, we do better with it and we can kind of achieve those goals of longer life with good quality.

Dr. Milind Desai:

Just a couple of comments I will make. So he's absolutely right. In a weird way, it's an annuity. You are a patient for life. It's not generally a one time situation. More important, there's two aspects to this, but especially thoracic aortic disease.

So above the diaphragm often tends to be familial, which means it is important to have your first degree relatives be thought of and be screened. We have a health screening program right in the Crile building and we were doing CAT scans like to look for coronary artery disease in asymptomatic individuals just walking into the Cleveland Clinic. Eight to 10% of these patients had a dilated aorta, just random normal folks, eight to 10%. So one in 10 who walked into the clinic for a simple calcium score, had an aortic, not an aneurysm, not reaching five centimeter, but did not know anything about their aortic disease which was abnormal.

So it is important, screening, but also screening of first degree family members. And once you are done with that index problem and the index operation it doesn't mean you are done. That's just the beginning of the conversation specifically for your follow up imaging, downstream imaging.

Dr. Frank Caputo:

Just to give you an idea of what the surveillance and this screening has done to change our practice patterns. I'm very fortunate to be surrounded by excellent cardiac surgeons here. And I'll tell you why. When you have a Type A dissection, this is a chronic issue. And the idea is when you have these type A dissections, it not only fixes your aorta, it not only fixes your dissection, but it sets you up for any type of future intervention you might need. Because nothing is worse than occasionally we get you through the acute process and you come back a year later and now that second operation's even harder than the first one you went through. And I think there are certain things that we've learned from surveillance and degenerative disease that you know what? The aorta is diseased, whether it's normal size and dissected now we know that 30% of those patients are going to form an aneurysm at some point in their life. So it's good forethought.

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