Aneurysms for Internists

John Elefteriades; Emily Farkas; Richard Gusberg; Dianna Milewicz

Aneurysms for Internists

Moderator:

John A. Elefteriades, MD

Yale University School of Medicine

Discussants:

Date: June 4, 2012

Roundtable ID: GM21704

Citation: Med Roundtable Gen Med Ed. ; 1(2): 112 - 120.

Summary:
Dr. John Elefteriades from the Yale School of Medicine, New Haven, CT moderated the topic "Aneurysms for Internists" with Drs. Dianna Milewicz from the University of Texas, Houston TX, Richard Gusberg from the Yale School of Medicine, New Haven, CT, and Emily Farkas from St. Louis University, St. Louis, MO.

The discussion focused primarily on:

1) The cause of aneurysms

2) genetic and environmental risk factors

3) genetic mutations that cause aneurysms

4) symptomology

5) dissections versus aneurysms

6) abdominal aortic aneurysms

7) aneurysms and enlargement

8) imaging and the use of computed tomography and ultrasound

9) medical therapies that forestall aneurysm growth or prevent complications

10) clinical trials

11) endovascular therapy and open surgical therapy for aneurysms.

Med Roundtable Gen Med Ed. 2012;1(2):112–120.

Compounds:
losartan

Trials:
No trials discussed.

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"We know the younger the patient is with thoracic aortic disease, the more likely there is to be an underlying genetic cause for the disease. The older the patient is … the less likely they are to have genetic risk factors and the more likely they are to have chronic wear and tear on the aorta over a lifetime causing the thoracic aortic disease."
~Dianna Milewicz

"Absent intercurrent aortic dissection, it’s unusual for the thoracic aorta to grow very rapidly, and usually the appearance of rapid growth or discrepant measurements between CT and echocardiography usually reflect measurement error … With an oblique measurement, the long dimension of the “hot dog” will be completely erroneous."
~John Elefteriades

"I think practitioners should be very comfortable passing along these patients to collaborate in the decision-making process … so that the surveillance can be done by the surgeon, and the decision can be made as to when to intervene and take that burden off of the internist."
~Emily Farkas

"I think the best way to best serve one’s patients is to have the patients referred to centers of excellence that have equivalent expertise in these various treatment modalities, both open and endovascular, such that the treatment can be individualized patient by patient."
~Richard Gusberg