The Get Healthy Tampa Bay Podcast

E114: Carotid Disease & Aortic Aneurysms Explained with Dr. Jenna Kazil

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast! This week, I’m joined once again by Dr. Jenna Kazil, a double board-certified vascular and general surgeon based in Bradenton, Florida.

In this episode, we dive deep into two critical topics: carotid artery disease and aortic aneurysms. Dr. Kazil explains how carotid artery blockages develop, the signs and symptoms to watch for, and the various surgical and medical treatment options available to prevent strokes. We also explore the causes and risks of aortic aneurysms, how and when they should be screened, and the latest techniques for repairing them, including minimally invasive procedures.

Whether you’re a healthcare provider or someone wanting to better understand these common vascular conditions, this episode offers practical insights and essential takeaways on prevention and treatment. Tune in to learn how early detection and the right intervention can save lives!

Dr. Jenna Caporaso Kazil is a double boarded general and vascular surgeon who works in Bradenton and Sun City Center, Florida. She has won multiple awards including the people’s choice award as well as physician of the year. She is the current vice chief of staff and former chief of surgery at HCA Florida Southshore Hospital. She enjoys robotic, open, and endovascular cases, doing a wide range of procedures. When she isn’t caring for patients, you can find her at the beach with her eight-year-old twins.

0:28 Welcome and guest introduction
1:27 What is carotid artery disease?
2:53 How blockages form and why this area is vulnerable
3:55 Signs and symptoms of carotid disease
5:34 Listening for bruits and screening
6:36 Carotid ultrasound and severity
8:49 Who needs treatment and how risks are evaluated
11:55 Three procedures to treat carotid disease
16:08 Medical management and prevention strategies
19:45 Intro to aortic aneurysms and risk factors

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Website: Website: www.floridasurgicalclinic.com

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Kerry:

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a returning guest, Dr. Jenna Kazil. Welcome back. How are you?

Jenna:

I'm good, thanks so much for having me.

Kerry:

I know we already had you on the podcast, but why don't you tell us a little bit about who you are and what you do so we can refresh our memories or in case somebody hadn't heard the previous episode on the peripheral vascular disease.

Jenna:

So, I'm a double boarded vascular and general surgeon in Bradenton, Florida, as well as sun city center and I pretty much do the skin and its contents. So, everything from arterial disease, hernias, hemorrhoids, lumps and bumps, but also aneurysms bypasses things like that.

Kerry:

Awesome. Yeah. So if we, you know, need more details of your journey into medicine, we'll go back to the other episode, but thanks for coming back on the podcast. Today we wanted to kind of go into another topic that you're an expert at, and that would be carotid artery disease. So what is carotid artery disease?

Jenna:

So I actually trained with the world expert in carotid disease. He wrote the books, most of the studies and so carotid disease is blockages in the arteries and the neck. Now, those are the arteries that are kind of in the front right here. We have four arteries that go to our brains. We have the two in the back, the vertebral arteries, and then the two in the front, the common carotid breaks into the internal and the external, the internal goes into our brains. The external feeds our face. And so when you get blockages, Especially along the internal carotid artery. Those little pieces of plaque can break off and cause strokes. And so the whole point of treating carotid disease is to try to prevent strokes.

Kerry:

So how does it happen in the first place?

Jenna:

It's a combination of diet and genetics. And lifestyle really smoking is 1 of the worst causes, just like, for PVD

Kerry:

so how does it like build up in that area? And why is that area more vulnerable than maybe a different one?

Jenna:

So that area you

Kerry:

know,

Jenna:

they talk about low stress and high stress forces and it tends to be a commonplace where plaque forms at that bifurcation where it splits off and anything really from where the, common carotid arteries take off from the aorta all the way up to the brain can can embolize. So it's really important that we treat these areas. And depending on how severe the stenosis is determines if there's anything that we really need to do or or not

Kerry:

So stenosis means like narrowing or blockages, right? And then we're talking about this black buildup that happens due to, you know, like the risk factors that you mentioned and how do people typically present or how do you even know that there could be a problem there?

Jenna:

So some people present with a transient ischemic attack, which is sort of we would call it some people call it a mini stroke. And that's really is what it is. There is some damage that's done where a little piece of plaque breaks off, goes to the brain and people can't speak for a few minutes, usually less than 24 hours. So they can't move 1 arm or 1 leg or their entire arm goes numb for some amount of time. And so they'll present to the hospital that way. The other thing that can happen is that they will have a complete or almost complete loss of vision and only in 1 eye. And so we talk about those old school window shades that come down over your eye and go maybe all the way or just halfway and come back and that's called amaurosis fugax and that's evidence of a stroke

Kerry:

Mm hmm.

Jenna:

piece of plaque crossing the ophthalmic artery. And that's an indication. A piece of plaque crossing up the artery and that's a reason to get your carotid at least looked at if not fixed.

Kerry:

this would be a great episode to have a visual of like the anatomy in the neck, right? It says all these arteries are coming off of like the main ones and I don't know if people really understand But I think it's it would be really interesting to you know, do that, but maybe next time. So you mentioned all these Like signs and symptoms, but you mentioned the T. I. A. The trans ischemic attack. Now that doesn't typically show evidence on imaging that anything happened. Is that correct?

Jenna:

Correct. Typically on an MRI, you're not going to see evidence of a stroke, but there is some, you know, microvascular evidence that something happened at some point. There was some amount of damage, even though it's not something we typically see on imaging.

Kerry:

Mm hmm.

Jenna:

people have an actual stroke, which would be where you can see real damage to the brain, and maybe their symptoms totally go away, but they have evidence of damage on imaging. And some people have absolutely no symptoms whatsoever. And they may only have an abnormal sound called a brewery in their neck. So when I listen to all my patients and patients, say well no one ever listens to my neck, and I listen to patients necks, and if you hear a high pitched wishing sound, I'll get an ultrasound and realize that for me, diagnostic standpoint, a 3rd of those patients have very severe disease. A 3rd of those patients have mild disease and a 3rd of those patients have no disease. So it can be challenging to determine who really needs a procedure and who does not. So that's why we get an ultrasound as a screening test and go from there,

Kerry:

Mm hmm. What's funny is I actually listen to everybody's neck too, and they're always like, what are you doing? Nobody ever does that. It's usually just maybe like the first time I meet them or maybe one like a well visit or something like that, but not every time I see them, but you know, it's one thing that could be easily, picked up and miss if you hear a loud sound. Well, actually, why don't you explain what does that brewery or that sound mean that we listen like over the carotid in the neck.

Jenna:

the sound means that the blood is traveling faster. And specifically, it's very specific. If you hear a diastolic brewery that that typically indicates that the stenosis is more than 90%.

Kerry:

Mm

Jenna:

So if you hear that sound, while the heart is kind of relaxing a little bit that's very concerning.

Kerry:

Okay, I didn't realize that but that's good to know. So. Oh, you said a third of the patients would have severe disease. So what does that mean with how much blockage there is? What does that mean for the next steps? And obviously you already mentioned the diagnostic thing is getting the ultrasound of the vessel.

Jenna:

Thats the 1st step in diagnosis and actually Medicare requires an ultrasound for different types of procedures that we'll talk about in a little bit. So I see ultrasounds all the time will say this patient has 47 percent stenosis and really, when you look at the studies, you can go by placking, but we're really looking at the velocities, which is a measurement of how fast the blood is traveling and the faster the blood travels, the more narrow the artery becomes. So, these elevated velocities, it's typically less than 50 percent 50 to 69 percent blocked or more than 70 or more percent blocked. And that being said, even if it's more than 70 percent blocked based on ultrasound, I'm not fixing patients if they are asymptomatic and they've never had a TIA. They've never had any stroke symptoms unless they are more than 80 to 90 percent blocked.

Kerry:

Okay. Wasn't there a previous like calculator thing that you put in for whether they have symptoms or not, whether you treat them or I'm just thinking of like the MD calculator. Do you know what I'm talking about?

Jenna:

typically with carotid disease, I will look at a couple of different things. 1 is how functional is this patient? So, I might have an 89 year old patient, but in Sun City, they are playing pickleball, they're working at a local store. They're volunteering, they drive, they have a million grandkids and they're very, very active and they have 90 percent carotid stenosis. I'm going to fix them. Typically in the past. We've said, if we don't think somebody's going to live 2 years that we wouldn't fix their carotid artery disease. Now, you know, we've been saying 5 years if we think this patient isn't going to live 5 years. So your diabetic patient on dialysis, who is wheelchair dependent and can't tell you what day of the week it is, is probably not an ideal candidate for an asymptomatic repair, but really any patient, unless they are too ill, so they have severe cardiac disease, or their mental function is really totally destroyed from their stroke. We're going to fix even if it's symptomatic,

Kerry:

Mm hmm. Yeah, those are important things to take into account, of course, like what the, you know, quality of life and their longevity and everything like that and explain why you aren't going to fix them. Like, what is the risk of the procedure? What are the procedures? And I know you want to go into all of that too.

Jenna:

So, there's, there's typically 3 different procedures that we talk about. And I'll go kind of from the oldest to the newest. So the oldest procedure is the carotid endarterectomy and there's a couple of different ways to do that. But typically you make a cut on the side of the neck about. Like this, and you just sat down to the carotid artery. You go right where it splits off into two different vessels and the internal, the external, and I put some vessel loops around those. You can give the patient a blood thinner. You open that up, you clean the whole thing out. And then I sew a patch on there. And that takes for me, you know, some patients, it might take 45 minutes, but typically for me, it takes an hour and a half to two hours by the time everything is said and done. And the biggest risk of any carotid intervention is stroke. So, if you have someone who's never had a stroke you need to talk about your risk of stroke and the traditional numbers are around 11 percent and we can take that risk down to 7 percent in about 2 years, which isn't really a huge change. So. We really need to think about the risk and the benefit. For some people, the benefit is the anxiety of, I could have a stroke at any point, and I just don't want to have to think about this. And I, I can't handle it. And I just want this done and they might be in their 50s or 60s, and that's very reasonable. The other risk, especially doing an open carotid surgery is the risk of cranial nerve injury, which can cause problems swallowing. It can cause numbness. Sometimes it can even cause difficulty using your tongue and speaking or some facial drooping as well. And for more than 90 percent of people, this resolves within a year. But for some people, they can have a really hard time swallowing and eating and that can be very challenging. And so you really want to consider if that needs to get done. The next type of procedure that. We typically think about that would be a transfemoral step. So we put an Ivy in the leg in the artery. We go up through the aorta backwards into the carotid artery and we put a stent in there. And the thing about that, the biggest risk is your risk of stroke, which typically, you know, I was taught is up to 10 percent for a symptomatic patient to have a stroke. Now, that might be a very small stroke, or they have some mild numbness or weakness, or that could be a debilitating. They don't know what day of the week it is, and they can't speak to you kind of stroke. And so that's not something to trifle with, so we really want to make sure that if we're doing that type of procedure, there's a very good reason. The 3rd type of procedure, which I would say, for me, is the most common and is my favorite procedure as a T car, which is trans carotid artery revascularization. I was part of their initial study, the ROADSTER 2 trial as a fellow, and I just really love doing these surgeries. They encompass so many of the things that I love about carotid endarterectomies and carotid stenting, and they're very safe. They are as safe, if not safer than open carotid surgery. And so, instead of making a big cut here, you have a very small cut, typically less than 2 inches, right over the base of the carotid artery at the neck, and then you're going to reverse the blood flow and you do that by going from a high pressure to a low pressure system. We put an IV in the leg in the vein rather than in the artery. And then we have some tubing and a filter system as well. And that prevents these little pieces of plaque from going to your brain. So we reverse the blood flow and typically my clamp time so the time without that side of the brain getting. Direct blood flow because the brain is getting blood flow from the other side of the head because you're pulling it in the opposite direction, for me is anywhere from 4 to 8 minutes, which is super duper fast and open carotid surgery if you're truly clamping, you know, for some people's anywhere from 20 to 45 minutes, I will typically shunt my patients and give, like, a little mini bypass during the procedure. But that's a whole different topic for another day and a function of of training and why and things like that. So it's very safe. It's very fast. I can do these procedures usually within 30 minutes as opposed to a 2 hour surgery. You can do them entirely under local. That's not really my favorite way to do them, but it's certainly possible. So I think there's a lot of really great things about it. The most important for me is the neuro protection.

Kerry:

Mm hmm. So does the blood flow go back again or is it permanently altered?

Jenna:

Yes. So once you're done with the procedure, it's restored to normal blood flow.

Kerry:

Okay. So it's just kind of rerouting it or?

Jenna:

You're rerouting it, so you actually occlude the common carotid here, and you're pulling blood from here to this high pressure system to the low pressure system in your leg, which is the venous system, and you're blocking the blood flow from going up so that you can kind of pull all of that and any little pieces of junk of plaque. Instead of causing a stroke or going down into the filter,

Kerry:

Okay, got it. And then does the filter get removed?

Jenna:

the filter is all external. So then once you're done, you no longer clamping the common carotid artery and let that off. You take out the filter system. You disconnect it from the patient and you're done. You close up and you're done.

Kerry:

You're basically cleaning it out using the high pressure blood flow in the other opposite direction to take the stroke risk away

Jenna:

yes, but you're also putting a stint in. So that's how you're getting rid of the blockage. You're putting a stent in.

Kerry:

Okay. Wow. I've never heard of that one. So definitely had you know, advances since I learned all this stuff. That's amazing. Really

Jenna:

I really, you know, the ROADSTER 2 trial that was going on in 2016. so we're talking about doing these procedures for less than 10 years. Really? For most people and they're, they're really fun. They're really fast. They have some downsides being that it's yes, you can do some intervention with some balloons and other stents, but you know, the stents are not the best thing for everybody. And you really need to look at that. And everybody's individualized.

Kerry:

yeah. So what can you outline and review? What is the stroke risk with each of the procedures? Because I think I wasn't sure if you were talking about the stroke risk from the procedure or the stroke risk of not doing a procedure.

Jenna:

So, for trans femoral artery, sending it to a typical stent from the groin, if you are a symptomatic patient, so, as in, you have had a stroke previously, your risk of having a stroke from the procedures, you know, up to 10 percent that's really high. In a symptomatic patient we talk about your risk of stroke from an open carotid surgery, or even a T car being up to 6 percent in my hands that's much, much lower. And then there's a national registry where each hospital will list each surgeons stroke rate for different types of procedures. so, essentially, you have to submit all this data. The hospital typically submits this data for you. It's usually called the VQI registry, but there's multiple different types of registries you could use potentially as a hospital system. And you want your stroke risk to be really less than 2 or 3 percent for all carotid procedures, especially the asymptomatic.

Kerry:

Wow. Yeah. That's I mean, these are, that's great to get that. So, well, we talked about all the different procedures, but what about medical management? Like do some cases just, you're not going to do a procedure. I mean, I know

Jenna:

Absolutely. Absolutely. So, you know, in Europe, typically, if someone is older, if we don't think someone's going to live 5 years, even if they have a high grade blockage, they're treating them with medications. So these are things like statin. So we're rosuvastatin, atorvastatin, which is lipitor and then anti platelets. And the 2 biggest anti platelets we use are typically aspirin and Plavix. And depending on what other medical problems the patient has really determines what we're going to do and which medication we're going to use. So, for instance, if I have a diabetic with PAD and he has carotid stenosis, I'm just going to leave him on Plavix and a statin. If I do a stent, whether that's from a transformal stent or a carotid artery, I'm sorry, a TCAR they're going to get aspirin and Plavix together for at least 30 days.

Kerry:

Okay. And then obviously prevention of it, where you talked about the lifestyle factors, not smoking and things like that. Is there anything else that you would make with that?

Jenna:

Blood pressure control is really important. So making sure those patients have an appropriate blood pressure, make sure that their hemoglobin A1c is appropriate. All of those things are super important and not smoking.

Kerry:

What kind of blood pressure goal?

Jenna:

as a surgeon, my blood pressure goals are typically much different than a primary care doctor blood pressures goals and and that's you know, for me, if I can get anybody under 150, I'm happy. I know national recommendations are typically, for diabetics I think they're closer to 120 or things like that, but, you know, less than 150 is typically what I'm looking for.

Kerry:

Nice. And that's what you're mostly focusing on the systolic then.

Jenna:

Correct. Yeah, but, you know, I know that there's national recommendations for other patients. That's that's not you know, it's not uncommon for me to have patients walk into my office with the blood pressure of 180, 190, 200 and we talk about, you know, hey, when's the last time you saw your primary care doctor? Do you see a nephrologist who's managing your blood pressure? What can we do about this? Because that becomes super dangerous.

Kerry:

Yeah. I mean, it makes sense, you know, like a lot of your descriptions about the physics of, you know, the vessels and the sizes and the pressure and the, you know, velocity of the blood that's going through there. If we just think back to our basic physics and like plumbing stuff that all kind of makes sense. Right. Yeah. Do you have anything else you want to mention about carotid artery disease?

Jenna:

I think it's really important that patients and other physicians referring these patients talk to their surgeons and see what their options are, because some people only do 1 versus the other, depending on their training. Typically, each hospital or each facility has somebody who's really good at doing trans femoral artery stenting because you really want 1 person doing it. And the reason for that is that the more you do, the better your numbers are going to be and you're kind of decreasing your overall risk. It's very typical for some people to only do certain things. So, for instance, I don't really do trans fermoral artery stenting anymore, but I do a ton of T CARs and I do open carotid surgeries. So, depending on which surgeon you go to, they may say, I only do this. I only do open carotid surgery. I only do T CARs. And I think it's really important that you make sure that you're looking at all of your options and why you're going to choose one particular procedure.

Kerry:

Yeah, that's definitely helpful and helpful for me too, like as a, you know, primary care doctor of who to send to and why, and maybe getting another opinion if needed.

Jenna:

Absolutely.

Kerry:

Yeah. Awesome. Well, our other fun topic was going to be aortic aneurysms. So why don't you explain what that means?

Jenna:

So aortic aneurysms are a dilation of the blood vessels. And so your aorta is the largest vessel in your body. It goes from your heart. It makes a big arc and it goes all the way down to about your belly button, where it splits into your right and left leg forming your right and left iliac arteries. And so an aneurysm, typically the ones that we think about an abdominal aortic aneurysm is going to be in your abdomen versus a thoracic, which is going to be more in your chest. And anything more than two times the normal size, which, you know, for most people is going to be around two ish centimeters is considered an aneurysm. The typical size that we're fixing these is usually around five and a half. Just for some background, when I was in training, we weren't fixing these unless they were six, six and a half, and because of all of the endovascular options, which are now available, we're fixing them at a smaller and smaller size. Typically, it's, it's around 5. 5 centimeters. There might be reasons to fix somebody at 5 but typically it's around 5. 5 centimeters. I tell my patients and I tell my primary care docs that around 3 to 4 centimeters, you want to at least getting them to see a vascular surgeon, because sometimes it might take a couple months to get in. And the reason could be anything from insurance to time of year, or how busy people are and that's not an emergency by any means. However, you should start thinking about talking about, hey, you know, you probably see a vascular surgeon once a year. If your aneurysms 4 centimeters.

Kerry:

Well, that's good information for me too. So what causes these aneurysms to form

Jenna:

So, 10 percent of these are genetic and that's why any patient who has 1, I will typically tell them that all of their 1st degree relatives need to be checked for an aneurysm 10 years before they were diagnosed. So, if I'm seeing a 75 year old guy and fixing his aneurysm, I will tell him that. Any first degree relative, so his siblings, typically his parents aren't alive and his children need to be checked at age 65. so that's 1 part of it. The other part of it is high blood pressure. So, again, the increase in pressure, decreasing wall thickness, and you get this dilation and then, you know, just the physics, the larger it is, the more likely it is to rupture. So that's where we're typically fixing these because we're trying to prevent rupture and, you know, most ruptures result in death. Typically, when you talk about you know, the rates of patients surviving a ruptured aneurysm, about half of those patients will die.

Kerry:

just to go over what the symptoms are of a rupture in case somebody doesn't know what would that be so they can run to

Jenna:

It's usually the worst abdominal or back pain you've ever had. And it's acute onset. It's not like, Oh, you know, I kind of ache and it's, it's usually just absolutely horrific pain and realize that your, your abdominal aortic aneurysm your entire aorta really is laying across your spine. So it's more so back pain than, than belly pain.

Kerry:

and who's so you said genetics and blood pressure, were there any other people at risk for developing these?

Jenna:

Anybody who smoked more than a hundred cigarettes. So and men typically more than women. So those are really the biggest risk factors.

Kerry:

Yeah, and I would say, you know, I think making sure that the primary care, you know, is during like a well visit is doing those screening tests and ordering that because we know that everybody who smoked and is male and what is the age. 65. We're supposed to be screening them.

Jenna:

So, you know, male smokers, more than 65, they need to be screened women with a family history who are heavy smokers, in my opinion, and have, you know, those are also reasons to to screen women as well.

Kerry:

what is the screening test?

Jenna:

It's an ultrasound, which is pretty easy to do. Although some of my patients are so obese that you really can't tell with an ultrasound and you can kind of get an idea, but you may miss something. And so then typically, I'll get a cat scan either with or without contrast because you're really just looking at the size of it. Does this look relatively normal or not?

Kerry:

And so when does it become like a problem that you need to do something? I mean, you mentioned the size, but,

Jenna:

So size, but also the rate of growth. So let's say you have a patient in your office and they came up at 3. 5 centimeters and you were going to get a repeat ultrasound next year. And now it's 4. 2 centimeters. It's grown more than half a centimeter in a year. That would be considered an aneurysm with rapid growth, and that would warrant repair that or just the overall size.

Kerry:

and so is there medical management or how does that work?

Jenna:

There's really not medical management. You know, once you get to a certain size, your, your options are to fix it, depending on how difficult the repair is going to be and what the risk is. Sometimes we wait to a larger size to fix it. So, for instance again, I guess it'd be great where we had some pictures, but if the aneurysm involves the arteries that feed all of your organs, so your celiac, your SMA, your IMA, that's a much different repair than a traditional, easy, straightforward 2 piece endovascular aneurysm. You're talking about like, a 45 minute procedure versus a several hour procedure risk of need for dialysis, things like that is very, very different. So, depending on what that looks like, really determines when we're going to fix it.

Kerry:

So just to clarify, you're talking about if it's feeding like the abdominal organs and everything

Jenna:

How extensive the aneurysm is what the way you fix it you have to have when you put your sense in the sense need to land in healthy areas. So we have the neck, which is typically right below the kidney arteries and then we need to have the end points down in the arteries, which feed the legs. But if you have aneurysms along this entire area now you really have to change the way you're going to fix it, whether that's using more stents, different types of stents. Or is this going to be an open old school repair, which is a completely different animal

Kerry:

okay. Well, can you go over the differences of the repairs or procedures that we do to fix that?

Jenna:

Sure. So the most basic endovascular repair would be 2 little tiny holes about this big in each 1 of your groins and we put IVs in there and then I put a scent in on either side and it looks like a pair of pants that sits right in your order. And it's a bypass from the inside out. That is the most basic straightforward repair. Depending upon what vessels are involved, you can use more and more stents and different types of larger graphs to kind of cover your entire aorta from your chest all the way down to your pelvis. And that becomes very, very involved, depending upon what exactly is involved and how many different vessels and things like that. And typically, the more parts of the aorta that you cover, you're increasing your risk of complications. This can be anything from bowel death to paralysis, which can be permanent.

Kerry:

So what do you, what is the goal of putting the stent in?

Jenna:

The goal is to prevent rupture. And really what you should be seeing when you get repeat imaging is the aneurysm sac itself should be shrinking. And we have pretty good data now that suggests that if your aneurysm is shrinking, you've done a good job and it's actually getting better.

Kerry:

So it's taking the pressure off of, you pooling of the, in the aneurysm, basically. Awesome. So you mentioned paralysis and some other things. What, how do we prevent all these things from

Jenna:

this is this gotten really involved really quickly. Essentially, you really need to know what you're covering and why and making sure that you're having adequate profusion of the rest of your organs. And sometimes that's decreasing the pressure and putting in a spinal drain. And those are typically things that if we think it's gonna be that bad, I'm not doing that by myself, a community hospital. That's something I'm going to send to a tertiary care center where they can really have everybody available. You might go on bypass. There's a whole bunch of different things you can do.

Kerry:

And then, well, what about open surgical repair did you

Jenna:

Open surgical repairs is a big surgery. So typically for my endovascular aneurysm repairs, those patients go home the next day and they're walking around doing other normal things and open aortic surgery. You're going to make a big, big belly cut from the bottom of your ribs, typically all the way down to your pelvis. And you're going to be in the hospital for at least a week. And it is a long recovery that also has a risk of damage to the kidneys going on dialysis, bowel death, et cetera. Those are all the same risks that are involved.

Kerry:

and which approach do you normally like to do?

Jenna:

Oh, endovascular everybody likes endovascular. It's, it's gotten to the point actually, where fewer and fewer people are doing open as far as training goes. And so they've decreased the numbers. Vascular surgeons need to be considered to be proficient. And so really, in my case. The hospitals just don't have everything that we need for open procedures. And I'm sending those to tertiary care centers because I feel that the patients are going to do better

Kerry:

Yeah, absolutely. That's kind of making it less risky for everybody. I think it makes a lot of sense. So if you have to do the care center, it's

Jenna:

and there's plenty of data that supports if you're not doing 10 of these procedures a year, and if your hospital isn't doing at least 10 of these procedures of year a year, you're going to have poorer outcomes than those that are.

Kerry:

is there anything else you'd like to add about the aortic aneurysms?

Jenna:

Just make sure that people are getting screened. So I think the number 1 thing that I would tell patients is that if you have a family history, if you're a smoker, you need to be screened and to bring that up to your primary care doctor, because you guys are super busy and there's a lot going on and that's probably low on your list of things to look out for in addition to high blood pressure and diabetes and high cholesterol and so bring that up to them so that they can get the appropriate screening done.

Kerry:

Yeah, definitely very important with the genetic component, which I don't know if I was so aware about so I think bringing that up to your doctor is going to be critical. Yeah,

Jenna:

It's not a very large percentage, but it is something. And then once you have 1 aneurysm, you're also more likely to have other aneurysms. So that could be aneurysms in the brain. That could be aneurysms behind the leg. That could be groin aneurysms. That could be aneurysms absolutely. Anywhere and those all get treated differently than your traditional infrarenal aortic aneurysm

Kerry:

Why wait? Why is it? Wait till 65 years old.

Jenna:

are national recommendations and I'm sure it has something to do with the risk benefit and the number of lives saved. But realize that people get cat scans now for anything, you know, any sort of abdominal pain, people are getting cat scans and a lot of the patients had a cat skin for a kidney stone or hernia or whatever it is. And they go, oh, yeah, I have this aneurysm. Okay. Well, let's let's work on that 1st

Kerry:

Mm hmm. Yeah, I mean, you're right. And there's so many other incidental findings, but this is definitely one that should be followed.

Jenna:

100%. Yes.

Kerry:

Yeah. Awesome. Well Why don't we, I don't know if we should cut it and do it next time, but maybe, maybe what I will do is say, you know, I think you know, thanks for coming on the podcast and I'm going to say, how can everybody find you? And then I think we'll go ahead and record the next time too for hernias if that's okay.

Jenna:

Sounds great. So people can find me at floridasurgicalclinic. com and in Bradenton, Florida, as well as Sun City. And my office number is 727 surgery, which is 727 787 4379.

Kerry:

Awesome. Well, thank you so much and everybody tune in next week for next week's episode.

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Dr. Kerry Reller

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