ABSTRACT
Nonspecific aortoarteritis (NAA) is an autoimmune disease characterized by the development of an inflammatory process in large arteries such as the aorta and its branches and pulmonary arteries. Operative interventions for lesions of the aortic arch branches may be divided into extra- and transthoracic. Involvement of all branches of the aortic arch requires transthoracic interventions to be performed. According to the findings of various authors, bicarotid bypass grafting is accompanied by a high incidence rate of complications and lethal outcomes. The most serious complication is haemorrhagic stroke developing in 40% of patients. That is why commencing from 1991 the practice of simultaneous restoration of the two carotid basins was discontinued. A clinical case report presented herein demonstrates the authors' therapeutic policy in patients with NAA and multiple involvement of brachiocephalic arteries and first of all with bicarotid occlusion.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Carotid Stenosis , Cerebral Hemorrhage , Postoperative Complications/prevention & control , Takayasu Arteritis , Adult , Aorta/diagnostic imaging , Aorta/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Brachiocephalic Trunk/diagnostic imaging , Carotid Arteries/diagnostic imaging , Carotid Arteries/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/prevention & control , Echocardiography/methods , Female , Humans , Risk Adjustment/methods , Takayasu Arteritis/complications , Takayasu Arteritis/diagnosis , Takayasu Arteritis/physiopathology , Takayasu Arteritis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler, Duplex/methodsABSTRACT
BACKGROUND: Severity of endothelial dysfunction and impairments of the vasomotor function of arteries correlate with the degree of the development of atherosclerosis and the risk of cardiovascular complications. To date, poorly studied still remains the problem concerning alteration of the regulatory function of the endothelium in patients diagnosed with pronounced atherosclerotic lesions of peripheral arteries, as well as the impact of a surgical intervention on indices of endothelial dysfunction. PATIENTS AND METHODS: Presented in the article are the results of preoperative study of the endothelial function by means of peripheral arterial tonometry (PAT) using the Endo PATTM 2000 device (Itamar Medical Ltd.) in a total of 74 patients undergoing surgical treatment at the Institute of Surgery named after A.V. Vishnevsky. The male-to-female ratio in the studied group was 1:2.52, with the patients' average age amounting to 67Ð}8 years. Of the 74 patients, 21 were subjected to a repeat examination performed at terms varying from 2 to 23 months postoperatively. Of these, 17 (80.95%) patients took statins. Fourteen (66.7%) patients had endured an operative intervention on carotid arteries and seven (33.3%) had been operated on for lesions of lower-limb arteries. RESULTS: The statistical analysis of the obtained findings revealed no significant differences of the indices of the endothelial function in the studied group between the genders, depending on age, smoking or taking statins. Neither were there statistically significant differences in the reactive hyperaemia index (RHI) amongst the patients with the involvement of one or several arterial basins. We did not reveal a direct relationship or regularity of the effect of a surgical intervention on the RHI values in the operated patients. This might be explained by the fact that the method of PAT to a greater degree assesses the state of the microvascular bed rather than that of large arteries.
Subject(s)
Arteries/physiopathology , Endothelium, Vascular/physiopathology , Manometry/methods , Microvessels/physiopathology , Peripheral Arterial Disease , Plaque, Atherosclerotic/physiopathology , Aged , Female , Humans , Male , Middle Aged , Perioperative Care/methods , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/physiopathology , Reproducibility of Results , Treatment Outcome , Vascular Surgical Procedures/methodsABSTRACT
This article is the review of the 59-th International Congress which had taken part in Izmir, Turkey at 15-18th April of 2010 year. There had been discussed important problems of cardiovascular surgery, especially endovascular treatment of the aortic diseases.
Subject(s)
Cardiovascular Diseases/surgery , Cardiovascular Surgical Procedures , Congresses as Topic , Societies, Medical , Europe , HumansABSTRACT
Current concepts of etiology and pathogenesis of nonspecific aortoarteritis (Takayasu's disease) are considered. A.V. Pokrovsky and his team gained the largest experience with diagnostics and treatment of patients suffering this disease. In this paper, the authors describe results of the treatment of more than 200 patients including 118 operated for isolated reconstruction of aortic arch branches (n = 43), restoration of blood flow only in thoracoabdominal aorta and its branches (n = 63), reconstruction of both brachiocephalic arteries and thoracoabdominal aorta (n = 12). The authors present their view of diagnostics and treatment strategy in patients with lesioned brachiocephalic arteries, abdominal and thoracoabdominal aorta. The necessity of following up patients in the postoperative period is emphasized.
Subject(s)
Takayasu Arteritis/diagnosis , Takayasu Arteritis/therapy , Diagnosis, Differential , Female , Humans , Male , Takayasu Arteritis/epidemiology , Takayasu Arteritis/etiology , Treatment OutcomeABSTRACT
Literature review is dedicated to the 100th anniversary of the first case presentation for nonspecific aortoarteritis. The review covers the history of the disease concept development, current knowledge on its etiology and pathogenesis, unresolved problems of management strategy for patients with this pathology.
