A former pack-a-day smoker, Shaw fits the profile of someone at risk for an aneurysm, even though he quit smoking more than two decades ago. That’s because current and former smokers are significantly more likely to develop an aortic aneurysm than nonsmokers. High blood pressure and family history are also risk factors.

The danger can go hidden because aneurysms don’t typically cause symptoms, although they can sometimes lead to indigestion, as was the case for Shaw, or more subtle issues. If an aneurysm keeps growing, it can burst—most people in whom this happens die from internal bleeding. That’s why vascular surgeons urge people like Shaw to get imaging tests that can help physicians find an aneurysm.

“If you have a family history of an aortic aneurysm, or you are a smoker, you should be screened,” said Cedars-Sinai vascular surgeon Elizabeth Chou, MD.

Chou explained that people at risk can see a primary care doctor, a cardiologist or a vascular surgeon for an imaging test such as an ultrasound or CT scan. Studies report that among people who get screened, about 3%-8% are diagnosed with abdominal aortic aneurysm.

An electrician and handyman who likes to stay active, Shaw had choices to make to prevent life-threatening rupture: minimally invasive catheter-based surgery or open surgery through an incision?

When Shaw met Chou, he learned his best option for his condition and lifestyle was an open surgery, where Chou and team would create an incision in the abdomen, sew a tube to the healthy parts of the aorta, and remove the aneurysm.

For people who have a smaller aortic aneurysm, a vascular surgeon will recommend an annual CT scan to see if it grows.

“Some aneurysms do not grow for many years,” said Chou, who is also assistant professor of Vascular Surgery in the Smidt Heart Institute at Cedars-Sinai. “Some people may never need surgery or any sort of repair, only routine monitoring.” She added that research is underway to help physicians understand why some aneurysms grow and some stay the same.

If an aneurysm reaches a certain size—about 5 ½ centimeters in men and 5 centimeters in women—a vascular surgeon typically recommends surgery.

Some patients may benefit from a minimally invasive surgery, during which a catheter is threaded through an incision in a patient’s groin until it reaches the aneurysm. The surgeon positions a tube in the area of the aneurysm and relines the aorta and aneurysm to divert blood flow into the relined aorta and away from the aneurysm. This option is usually recommended for patients who are older, frail, and generally wouldn’t recover well from an open surgery.  Some people also choose this option because they prefer a less invasive approach and are willing to undergo annual follow-ups to make sure the relining remains intact.

Shaw felt confident in Chou’s recommendation for an open surgery

“I live on a ranch,” he said. “I toss around bales of hay and 50-pound bags of horse feed. I need to be totally well. Anything other than a completely replaced artery was not acceptable because of my lifestyle.”

Chou said the most important part of the process is for patients to understand what the aneurysm is and how it affects their life.

“There are pros and cons to open surgery, minimally invasive surgery, and watching and waiting,” she said. “Our utmost priority is ensuring that each patient is comfortable with their decision. What we want people to know is that they need to be screened, and we will take the next steps together.”

After almost a week of recovery in the hospital and four weeks of recovery with light activity at home, Shaw returned to horseback riding on his ranch in Santa Maria, California.

“This could have ruptured at any time,” he said. “I was a walking time bomb. Now I’m totally healthy.”

Read more on the Cedars-Sinai Newsroom: Smidt Heart Institute Opens Aortic Surveillance Clinic

The clinic is the newest offering from the heart institute’s dedicated Aortic Program, an interdisciplinary team of highly specialized cardiologists, cardiac and vascular surgeons, radiologists, genetic counselors, and nurses treating the full spectrum of aortic disorders.

“When patients hear that they have an aortic aneurysm, they often think they are ticking time bombs, but that is not always the case,” said Robbin Cohen, MD, professor of Cardiac Surgery and director of the Cardiac Surgery Program at Huntington Health, a Cedars-Sinai affiliate. “Most of the patients that we see—many with genetic conditions affecting the heart—have aortas that are not large enough or serious enough to need surgery, but they do require ongoing monitoring.

“Through the Aortic Surveillance Clinic, we offer reassurance that they are being carefully and closely monitored and that proper therapy, including surgery, will be offered if needed.”

Smidt Heart Institute patients benefit from access to a multidisciplinary team including cardiac and vascular surgeons skilled in treating a range of aortic conditions.

“We take pride in our collaborative approach, which benefits patients with various complex aortic diseases,” said vascular surgeon Ali Azizzadeh, MD, professor and director of Vascular Surgery, associate director of the Smidt Heart Institute at Cedars-Sinai and an aortic aneurysm expert. “Our team is versed in innovative, minimally invasive procedures, in which cardiac surgeons and vascular surgeons are thorough and thoughtful in how best to manage each individual patient’s needs.”

Cohen has more than 25 years of experience monitoring and treating patients with aortic aneurysm.

“Aortic surgeons know that over time, they will accumulate hundreds of patients with aneurysms that they are following and not operating on,” Cohen said. “This requires expertise in aortic imaging, the natural history of aortic disease, and the guidelines and criteria for surgery—areas in which the Smidt Heart Institute team is highly skilled.”

The aorta is the largest and most important artery. It carries blood away from the heart into the rest of the body. Careful monitoring of a significantly enlarged aorta, or aortic aneurysm, can help prevent the possibility of a life-threatening condition, such as aortic dissection—a tear that develops along the inner layer of the aorta.

The Aortic Surveillance Clinic also provides expert care for patients with certain genetic syndromes, such as connective tissue disorders like Marfan syndrome and Loeys-Dietz syndrome, as well as other genetic disorders affecting the aorta and aortic valve, such as Turner syndrome. These patients are at high risk of developing an enlarged aorta and subsequently, a tear or dissection in the aorta due to abnormalities in the heart and blood vessels. Because these disorders also can affect other areas of the body, the Aortic Surveillance Clinic goes a step further and addresses these issues by connecting patients with genetic counselors, ophthalmologists, orthopedists, psychologists, reproductive endocrinologists and other specialists, as needed.

“We are pleased to have the ability to focus on a subset of patients when they don’t need surgery—and educate them on how to prevent acute aortic events, which can be fatal,” said Joanna Chikwe, MD, chair of the Department of Cardiac Surgery and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai. “And if these patients do need surgery—which can be complex and challenging—the Smidt Heart Institute has the expertise of a comprehensive, multidisciplinary team to take care of them, with superb results.”

The Aortic Surveillance Clinic is located at 127 San Vicente Blvd., in Los Angeles and is open for patient evaluation the second Friday of each month. Patients can call 310-423-3851 for more information.

Cedars-Sinai once again has been recognized by U.S. News & World Report, this year as the #2 program in the nation for Cardiology, Heart & Vascular Surgery. The Smidt Heart Institute is also #1 for Cardiology, Heart & Vascular Surgery in California and Los Angeles (highest U.S. News ranking in the region).

Read more on the Cedars-Sinai Blog: The Cedars-Sinai Specialist Aortic Service and Acute Aortic Dissection

The addition of Teruya and Schonefeld means that patients throughout the San Gabriel Valley now have expanded access to Cedars-Sinai’s top-ranked vascular surgeons and programs.

“We are pleased to welcome Dr. Teruya and Dr. Schonefeld to the Smidt Heart Institute, providing expert treatment and care for patients with arterial and venous diseases,” said Ali Azizzadeh, MD, professor and director of Vascular Surgery and associate director of the Smidt Heart Institute. “With the addition of these skilled surgeons, we continue to broaden our world-class vascular program at Huntington Health, which is the most comprehensive and innovative facility for vascular care in the San Gabriel Valley.”   

Teruya earned a bachelor’s degree from Occidental College in Los Angeles and a medical degree from John A. Burns School of Medicine at the University of Hawaii. He completed his general surgery residency at the University of Hawaii and a vascular surgery fellowship at Loma Linda University Medical Center.

Teruya has published extensively on a range of arterial and venous disorders. He is board-certified by the American Board of Surgery and is an active member of the American College of Surgeons and is a distinguished fellow of the Society of Vascular Surgery. His academic interests include surgical education and clinical outcomes in vascular surgery. 

Teruya also serves in the U.S. armed forces as commander of the Medical Corps for the Navy Reserve. He is an Afghanistan War veteran who received both a Navy Commendation Medal and a Navy and Marine Achievement Medal.

“I’m thrilled to join the Smidt Heart Institute team, and I’m looking forward to building strong relationships with patients seeking care at Huntington Health, as well as with a team of expert providers,” Teruya said. “To be part of an exceptional health system like Cedars-Sinai—one that prioritizes delivering high-value services to patients, envelope-pushing innovation including clinical trials, and overall excellence in patient care—marks an exciting next chapter in my career.” 

Schonefeld earned her bachelor’s degree from Stanford University and her medical degree from McGovern Medical School at the University of Texas Health Science Center at Houston. She completed a general surgery internship and residency at the University of Arkansas for Medical Sciences in Little Rock, as well as a vascular surgery fellowship at Cedars-Sinai.

She has authored or co-authored more than 20 publications, book chapters, presentations and abstracts and is a member of multiple professional organizations, including the Society for Vascular Surgery and the American College of Surgeons.

“Having just completed my fellowship at Cedars-Sinai, where I had a terrific vascular surgery training experience, I’m proud to now have the opportunity to join the highly regarded Smidt Heart Institute team,” Schonefeld said. “I look forward to delivering the highest standards of care to patients throughout the San Gabriel Valley, as well as being able to offer them improved quality of life and life expectancy, thanks to new discoveries in diagnostics, treatments and more.”

Cedars-Sinai once again has been recognized by U.S. News & World Report, this year as the #2 program in the nation for Cardiology, Heart & Vascular Surgery. The Smidt Heart Institute also is #1 for Cardiology, Heart & Vascular Surgery in California and Los Angeles. 

Read more on the Cedars-Sinai Blog: Aortic Service and Acute Aortic Dissection