Double strengthening of the neck of the aortic aneurysmal sac

INTRODUCTION. The article presents the experience of treatment of abdominal aortic aneurysms from 2011 to 2016 using the author’s technology, which contains the method of double strengthening of the neck of the aortic aneurysm, on the basis of the Department of Hospital Surgery in the Department of Vascular Surgery of the RCH of Nalchik.

METHODS AND MATERIALS. According to this method, 202 patients with abdominal aortic aneurysm (group I) were operated on, 116 were admitted as planned, 86 were admitted as emergency and urgent, while 183 were men and 19 were women. Without using the technique of double  strengthening of the aneurysm neck, 205 patients were selected for the period from 2006 to 2011. They were included in group II. Among them, 118 were received as planned, 87 were received in special and urgent cases. The patients were examined thoroughly. CT angiography in 3-dimensional reconstruction was performed using special research methods.

RESULTS. All patients were transferred to the intensive care unit after the operation. In the operative and immediate postoperative periods, among the operated patients admitted in an emergency and urgent, 19 patients with a ruptured aortic aneurysm died in group I, 23 patients – in group II. Among the planned patients, 2 in group II died from a combined severe concomitant pathology. All other patients were activated on the 2nd-3rd day, and subsequently discharged in a satisfactory condition.

CONCLUSION. The advantages of the proposed method of surgical treatment of abdominal aortic aneurysm are: technical simplicity of execution, double strengthening of the neck of the aneurysmal sac, tightness of the anastomosis, therefore, the reduction of intraoperative blood loss, the possibility of performing aortic prosthetics with suprarenal and renal aneurysms and weakness of the wall in the neck area in the absence of an artificial circulation apparatus.

1. Pleumeekers H. J., Hoes A. W., van der Does E., van Urk H., de Jong P. T., Grobbee D. E. Aneurysms of the abdominal aorta in older adults. The Rotterdam Study // American Journal of Epidemiology. 1995;(142):1291– 1299. Doi: 10.1093/oxfordjournals.aje.a117596.

2. Singh K., Bonaa K. H., Jacobsen B. K., Bjork L., Solberg S., Prevalence of and Risk Factors for Abdominal Aortic Aneurysms in a Populationbased Study: The Tromsø Study // American Journal of Epidemiology. 2001;(154):236–244. Doi: 10.1093/aje/154.3.236.

3. Lederle F. A., Johnson G. R., Wilson S. E., Chute E. P., Littooy F. N., Bandyk D., Krupski W. C., Barone G. W., Acher C. W., Ballard D.J. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group // Ann Intern Med. 1997;(126):441–449. Doi: 10.7326/0003-4819-126-6-199703150-00004. PMID: 9072929.

4. Belov Yu. V., Komarov R.N., Savichev D. D. Surgery of thoracic and thoracoabdominal aortic aneurysms: history and modernity // Cardiology and cardio-vessel. hir. 2008;1(1):37–42. (In Russ.).

5. Kohan E. P., Zavarina I. K. Selected lectures on angiology. 2006:476. (In Russ.)

6. MacSweeney S. T., O’Meara M., Alexander C. et al. High prevalen- ce of unsuspected abdominal aortic aneurysm in patients with confirmed symptomatic peripheral or cerebral arterial disease // British Journal of Surgery. 1993;80:582–584. Doi: 10.1002/bjs.1800800510.

7. Clinical Angiology: a guide for doctors: in 2 volumes / eds by A. V. Pokrovsky. Moscow, Medicina, 2004:194. (In Russ.).

8. Aslanov A.D., Zhigunov A. K., Logvina O. E. et al. Simultaneous operations in cardiovascular surgery // Cardiology and cardiovascular surgery. 2010;(6):54. (In Russ.).

9. Belov Yu. V., Komarov R. N. Are simultaneous operations expedient for combined aneurysmal aortic disease?// Thoracic and cardiovascular surgery. 2006;(5):58–61. (In Russ.).

10. Kazanchyan P. O., Popov V. A., Sotnikov P. G. et al. Surgical tactics in patients with abdominal aortic aneurysm and ischemic heart disease // Thoracic and cardiovascular surgery. 2008;(2):30–35. (In Russ.).

11. Lemenev V. L., Mikhailov I. P., Shcherbkzh A. A. Experience of surgical treatment of patients with ruptured abdominal aortic aneurysms // Angiology and vessel. hir. 2001;7(4):96–102. (In Russ.).