[Results of endovascular treatment of abdominal aortic aneurysms].

OBJECTIVE: Studying the results of endovascular prosthetic repair in patients with abdominal aortic aneurysms. MATERIAL AND METHODS: A retrospective study of 34 elderly and aged patients (mean age 67.4±1.24 years) with severe concomitant pathology and the risk of Euroscore averagely amounting to 13.16±0.19, subjected to endoprosthetic repair for the presence of AAA. RESULTS: In all 34 cases we obtained good immediate results of endoprosthetic repair of the infrarenal portion of the abdominal aorta: positioning of stent grafts was adequate, expansion complete, with no sign of endoleak. Hospital lethality rate was 0%. The intra- and postoperative periods were not accompanied by the development of neither cardiological nor neurological complications. Analysing by the McNemar criterion showed that there was a statistically significant trend towards elevation of leukocytosis and ESR after surgery (p=0.074), and for other indices the shifts were statistically insignificant or absent. Since no signs of an inflammatory process were revealed, in all cases the postoperative wounds healed with fist intension, the alterations in the blood formula were associated with resorption of thrombotic masses in the paraprosthesis space. CONCLUSION: In all cases, implantation of the stent graft resulted in achieving the main objective, i. e. adequate isolation of the aneurysmatic sac in AAA. Dynamic follow up did not reveal any cases of stent graft dislocation, aneurysm rupture, thrombosis of endograft branches, or type 1a leaks.

[First experience with monitoring somatosensory and motor evoked potential during operations on the thoracic and thoracoabdominal portions of the aorta].

Specialists in Russia have recently gained vast experience in operations on the thoracic and thoracoabdominal portion of the aorta; however, studying evoked potentials for preventing lesions of the spinal marrow have not been studied in any clinic. The authors report herein their first experience in Russia in studying the function of the marrow during operations on the aorta followed by detailed description of the technique of registering evoked potentials. From June 2010 to January 2011, specialists of the Arterial Pathology Department of the A. N. Bakulev Scientific Centre for Cardiovascular Surgery under the Russian Academy of Medical Sciences carried out a neurophysiological study in a total of 19 patients during operations for thoracic and thoracoabdominal aortic aneurysms. The somatosensory and motor evoked potentials were studied using an 8-channel neuroenhancer Keypoint (Dantec, Denmark). The hospital mortality rate in the examined group amounted to 5.2% (1/19). Spinal stroke developed in 2 patients, i.e. in 10.5% (2/19). The alterations in the somatosensory and motor evoked potentials were subdivided into groups according to the morphological classification of Crawford-Cunningham. A further two patients were found to have during operation type III changes in the evoked potentials, with both having developed postoperative spinal stroke. Thus, the method of intraoperative monitoring of evoked potentials has high sensitivity and specificity and can be included into the protocol of operations on the thoracic and abdominothoracic portion of the aorta. During monitoring of evoked potentials it is necessary to maintain a permanent level of anaesthesia and myorelaxation with obligatory participation of the neurophysiologist in the operation.

[Remote results of open interventions in treatment of abdominal aortic aneurysms].

Analysed herein are the results of treating a total of 471 patients operated on at the Department of Surgical Treatment for Arterial Pathology of the Research Centre of Cardiovascular Surgery named after A. N. Bakulev under the Russian Academy of Medical Sciences for an aneurysm of the infrarenal portion of the abdominal aorta. Complicated forms of AAA were observed in 71 (15.1%) patients. Of these, 13 patients were admitted presenting with a clinical picture of aortic rupture, 56 patients with aortic wall tear (according to ultrasound and/or MSCH findings), and two patients had break of the inferior vena cava. The most frequently encountered accompanying diseases were as follows: CAD noted in 367 (78.2%) patients. Valvular heart defects were revealed in 68 (14.4%) patients. Atherosclerotic alterations of the ascending aorta were diagnosed in 97 (20.6%) patients, and an ascending aortic aneurysm in 14 (2.8%) patients. Operations on the heart were performed in 45 (19.1%) patients. Mitral valve plasty was carried out in 7 patients, and 11 patients had a history of prior interventions on the aortic root and ascending aorta (Bentall-De Bono operation in 3 patients, Carbol operation in 3 patients). 32 patients underwent reconstructive operations on coronary arteries. Transmyocardial laser revascularization of the myocardium was carried out in 4 patients. Endovascular interventions were performed in 32 (6.8%) patients (stenting or transluminal balloon angioplasty of coronary arteries). All patients underwent AAA resection with prosthetic repair. The mentioned operations were combined with the following simultaneous interventions: aortocoronary bypass grafting performed in 31 cases, carotid endarterectomy in 27 cases, and plasty of renal arteries was carried out in 48 patients. Complications in the immediate postoperative period were observed in 79 (16.8%) patients. Hospital mortality amounted to 11 (2.3%) patients. The cumulative survival rate after 1, 5 and 10 years after surgery amounted to 93%, 81% and 44%, respectively, in a complicated course amounting to 91%, 79% and 16%, respectively. The obtained findings of the study demonstrated that the results of the AAA resection should be regarded as fairly good. The main factors influencing the quality of life and surgical outcomes in abdominal aortic aneurysms are as follows: CAD, arterial hypertension, and chronic cerebrovascular diseases. In patients without accompanying diseases, the criteria of quality of life after surgery approximate to those in a healthy population.

[Extra-anatomical bypass grafting from the ascending to the descending aorta combined with removal of the thoracic-aorta stent graft and a para-aortic abscess following endoscopic repair of the descending portion of the thoracic aorta].

The outcomes of reconstructive repair operations for aneurysms of the descending portion of the thoracic aorta typically appear to be relatively satisfactory. However, a certain cohort of patients presenting with the pathology concerned require repeated secondary interventions due to the development of false aneurysms in the area of the anastomosis and infection of the synthetic vascular stent graft, with the number of such patients steadily increasing with each year. The authors describe herein a clinical case report regarding successful treatment of a patient diagnosed with an infected pseudoaneurysm of the descending portion of the thoracic aorta after an endovascular repair operation. This case report demonstrated a present-day approach to appropriate treatment of patients presenting with the pathology involved.

Surgical methods of protecting the spinal cord during reconstructive operations on the thoracic and thoracoabdominal portions of the aorta.

BACKGROUND: Restoration of the spinal blood flow during operations on the thoracoabdominal portion of the aorta is one of the basic and decisive methods of protecting the spinal cord from ischaemia. OBJECTIVE: To decrease the incidence rate of spinal complications during interventions on the thoracic and thoracoabdbminal portions of the aorta at the expense of choosing an appropriate option of aortic reconstruction, determined by preoperative diagnosis of peculiarities of blood supply of the spinal cord. MATERIALS AND METHODS: From November 2005 to April 2007, a total of 34 patients were operated on at the Department of Arterial Pathology. To determine the spinal blood flow, all the patients were subjected to multispiral CT angiography. In 35% of patients underwent prosthetic repair of the thoracic and abdominal portions of the aorta with leaving a nondilated portion part from which originated the identified "critical" artery. In 45% of the reconstructions the verified "critical" artery was included into the distal oblique anastomosis. In 10% of cases, restoration of the blood flow of the spinal cord was performed at the expense of reimplantation of the segmental artery into the graft on the platform. In cases when the "critical" arteries were not involved into the pathological process, we performed isolated prosthetic repair of the aortic portion affected. RESULTS: The great anterior radiculo-medullary artery was visualized in 26 (76.5%) patients, and the anterior spinal artery--in 34 (100%) patients. The overall operative mortality rate amounted to 8.8%. Spinal complications were observed in 2.9% of cases (one patient was subjected to ligation of the 10th intercostal artery preoperatively defined as "critical"). CONCLUSION: Blood flow along the diagnosed "critical" segmental arteries should be restored in all operations on the thoracic and thoracoabdominal portions of the aorta.