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%.