Surgical treatment of complicated abdominal aortic aneurysms.

The clinical data presented in the given work are based on the treatment of 166 patients with complicated abdominal aortic aneurysms, operated on during 20 years, namely between 1984 and 2004. Of these, aneurysmal rupture was identified in 51 (30.7%) and the risk of rupture in 115 (69.2%) cases. Coexistent pathology was present in 150 (90.4%) patients. Coronary artery disease was prevalent - 105 (63.3%) cases. The lethal outcome was recorded in 21.6% of cases (36 pts.). The basic cause of patients' death in the short-term postoperative period was acute cardiovascular insufficiency (9.6%).

[The use of low-molecular heparins in reconstructive surgery of ascending aortic aneurysms]. / Primenenie nizkomolekuliartnykh geparinov v rekonstruktivnoi khirurgii anevrizm voskhodiashchego otdela aorty.

This paper analyzes the results of the use of enoxaparin for anticoagulant therapy in reconstructions on the ascending aorta (AA) as compared to unfractionated heparin applied previously in the control group. Between 1986 and 2003 a total of 30 patients with AA aneurysms were operated on at the clinic. Insufficiency of the aortic valve with degree II-III regurgitation was present in 25 (83.3%) cases. Chronic dissection of the AA was identified in 10 (33.3%) cases. The patient's age varied from 24 to 52 years (mean 39 years). The etiological factors of AA aneurysm were: Marfan's syndrome (46.7% of cases), Erdheim's syndrome (26.7%), atherosclerosis (10.0% of cases); previous chest traumas were recognized in 16.6% of patients. All the patients were operated on under extra-corporeal circulation and moderate hypothermia. The patients were distributed into two groups. In the control group, eighteen patients were operated on. Anticoagulant therapy was carried out using unfractionated heparin i. v. in a daily dose 10-15 thousand units. Heparin injection was initiated on the first postoperative day and continued for 6.5 days on the average, with a progressive change over to the use of indirect anticoagulants. In the basic group, twelve operated patients were administered the anticoagulant enoxaparin s.c. in a daily dose 0.7-1.0 mg/kg bw. Enoxaparin therapy was initiated from the first postoperative day and continued for 8.9 days on the average, with a progressive change over to indirect anticoagulants. The postoperative lethality in the control group accounted for 22.2% (4 patients). In two cases, it was induced by heart failure and in two cases, by hemorrhagic complications. In the basic group, the beneficial results were achieved in 91.7%; no hemorrhagic complications were recorded. The data obtained allow the conclusion that the use of enoxaparin significantly facilitates the postoperative management of patients with AA aneurysms, providing for a controllable and safe anticoagulant effect.