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A Five-Year Experience of Sparing Treatment of Descending Aortic Atherosclerotic Aneurysms

World Journal of Cardiovascular Surgery 2016年第4期6卷 47-54页

作者： Vladimir Petrovich Krylov alexander gennadyevich mrochek Valentina Nukolaevna Gayduk Leonid Ivanovich Reut Aleksey Leonidovich Smaliakou Nadezhda Vladimirovna Mankevich Roman Nikolaevich Pizhik Republican Research and Practical Centre “Cardiology” Ministry of Health of the Republic of Belarus Minsk Belarus

A growing number of specialists are now beginning to ascertain that treatment of individuals with descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development of conservative treatments and elaboration of indications for surgery. A total of 97 patients with thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have been examined over a 5-year period. They received multifaceted anti-inflammatory medical treatment to strengthen the aortic wall and control its possible expansion. Operative treatment was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting mortality is the presence of co-morbidities requiring permanent medical corrective treatment irrespective of surgical or medical treatment provided. It is also important to outline the indications for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant longer survival in DAA patients.

关键词： Aortic Atherosclerotic Aneurysms Surgical Treatment Conservative Treatment Outcomes

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Can We Change a Look at Atherosclerotic Aortic Aneurism Treatment?

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Health 2014年第12期6卷 1345-1351页

作者： Vladimir Petrovich Krylov Аlexander gennadyevich mrochek Leonid Petrovich Titov Valentina Nikolaevna Gaiduk Leonid Ivanovich Reut Аleksey Leonidovich Smaliakou Republican Scientific and Practical Centre “Cardiology” Ministry of Health of Belarus Minsk Belarus Republican Scientific and Practical Centre “Cardiology” Ministry of Health of Belarus Minsk Belarus Republican Scientific and Practical Centre “Epidemiology and Microbiology” Ministry of Health of Belarus Minsk Belarus

In recent years, the increasing number of cardiologists and cardiac surgeons tend to think that surgical treatment of patients with atherosclerotic aneurisms does not fully comply with contemporary ideas of what the disease is. Some data show that early operations in the presence of this pathology are associated with an unreasonably high mortality. Additionally, the use of intra-aortic stents and grafts cannot principally affect the therapeutic efficacy. Therefore, more attention is paid to the development of conservative therapeutic approaches leaving surgery defeated without surgical treatment. Two groups of patients with similar descending thoracic aortic atherosclerotic aneurisms (DTAAA) and abdominal aortic aneurisms (AAA) were retro- and prospectively studied over a 2-year period. Control group (Comparison group), (63 patients) received common surgical treatment from 2009 to 2010 whereas Main group (121 subjects) received multifaceted medical treatment to remove inflammatory reactions, strengthen aortic wall and control its dilation from 2011 to 2012. Operative treatment was used only in case of potential aneurism rupture. The comparison of the two groups of subjects showed that 2-year all-cause mortality in control group was 20.6% while in the main group it amounted to 9.1% due to the similar incidence of aneurism ruptures and deaths associated with concomitant diseases. It suggests that the odds ratio (OR) of survival when using attenuated therapeutic approach to treating atherosclerotic aneurisms is 2.6-fold higher compared to conventional surgical approach. One of the principal factors contributing to a higher mortality when using traditional surgical approach was the presence of polyorgan pathology that required constant medical correction irrespective of therapeutic option (surgical or medical) used. Another important factor is aortic aneurism wall frailty. The development of mechanisms that would allow its strengthening is considered a principal challen

关键词： Atherosclerotic Aortic Aneurisms Surgical and Conservative Treatment

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