[Outcomes of endoprosthetic repair of abdominal aortic aneurysm]. / Rezul'taty éndoprotezirovaniia anevrizmy briushnogo otdela aorty.

AIM: The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts. PATIENTS AND METHODS: We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella - 44, Ovation Prime - 33, Anaconda - 13, Endurand - 77, Aortix - 2, Zenith - 33, Seal - 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations. RESULTS: Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case - the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak - 3.7%, type IB - 4.13%, type IIA - 6.6%, type IIB - 4.54%, type III - 0.83%, type IV - 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21). A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR - 1; 95% CD 1- 1; p=0.026). CONCLUSION: Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.

[Results of endoprosthetic reconstruction in patients with aneurysm of the infrarenal portion of the aorta].

The authors herein share their experience with implantation of endografts in a total of 41 patients for an aneurysm of the infrarenal portion of the aorta. Of these, there were 34 (83%) men and 7 (17%) women, with the average age amounting to 71±7 years. All patients were found to have a history of coronary artery diseases (CAD) and arterial hypertension. The first stage in 15 (36.6%) cases consisted of stenting of coronary arteries and in 8 (19.5%) cases of coronary aortic bypass grafting. Seven patients were within 6 months diagnosed as having developed thrombosis of the stent-graft s branch, treated by recanalization with stenting in 5 cases, and by femoro-femoral cross-over bypass in 2 cases. One patient was found to have stenosis due to bending of the left branch of the stent-graft corrected by stenting; two patients showed endoleak (in one case that of type 2 due to retrograde blood flow from lumbar arteries and in the second case that of type 3 due to impairment of the stent-graft covering integrity). Thromboembolism into the distal bed during implantation of stent-grafts was verified in 3 cases, with two of them requiring thrombectomy. One more patient was diagnosed as having dissection of the intima of the iliac artery, treated by stenting of the arterial segment involved. There were no other complications, nor lethal outcomes.

Choice and stages of a surgical intervention in patients with infrarenal abdominal aortic aneurysms and combined lesions of the coronary bed and brachiocephalic arteries.

The authors have investigated and describe herein the outcomes of surgical management of two groups of patients presenting with uncomplicated infrarenal abdominal aortic aneurysms (AAA) and operated on within the time frame from 1998 to 2010 by means of various treatment modalities for concomitant lesions of the coronary bed and brachiocephalic arteries. Group One comprised a total of sixty-nine patients having endured surgical treatment for AAA on the background of medicamentous prevention of possible cardiac and cerebral complications. This group included the patients treated in the settings of the Department of Vascular Surgery of the Medical Centre of the State Medical University of the city of Semei and Municipal Hospital №1 of the city of Pavlodar. Group Two comprised a total of eighty patients subjected, if indicated, as the first stage to surgical correction of circulatory disorders in the system of the coronary bed and brachiocephalic arteries, with the final stage being an intervention on the abdominal aorta. These patients underwent treatment at the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin (hereinafter referred to as NSRICP). The obtained therapeutic outcomes were analysed in both immediate and remote postoperative periods. The long-term results within the time frame ranging from 12 months to 12 years were followed up in forty (58%) Group One patients and within the terms varying from 12 months to 6 years in fifty-seven (71.2%) Group Two patients. Analysing the findings obtained showed that combined lesions of the coronary bed were observed in 88.4% of cases in Group One and in 80.0% of Group Two patients. Concomitant lesions of the brachiocephalic arteries were diagnosed in 15.9% of Group One patients and in 38.7% of Group Two patients. Preliminary surgical correction of the coronary blood flow made it possible to decrease the complication rate from 10.1% to 1.2% in the early postoperative period, and form 15.0% to 1.7% in the remote postoperative period, as well as to dramatically decrease the perioperative lethality rate from 23.2% to 7.5%. Surgical correction of haemodynamically significant lesions of the brachiocephalic arteries prior to the main stage of the operation made it possible to decrease the incidence rate of the development of acute cerebral ischaemia (ACI) in the remote period from 12.5% to 1.7%. The actuarial 5-year survival rate in Group One patients was 77.5%, with that for Group Two patients amounting to 91.3%.