[An adverse effect of arterial hypertension on the outcomes of endovascular grafting of aortic aneurysms].

Today distant transluminal aortic grafting as a method for the treatment of aneurysms of varying sites and etiology holds a steady position in all the developed countries of the world. Powerful industrial support makes it possible to widely introduce into clinical practice an ever more perfect and reliable appliances. Over the recent years the direct outcomes of operations have significantly improved, the indications for surgery have been broadened. Universal approaches to the assessment of surgical outcomes and complications have been formed. Experimental studies pertaining to the method development have become more goal-oriented. The quality of the in vitro experimental studies allows the conclusions to be drawn, which are afterwards are supported and can be used in clinical practice. An experience gained over the recent years has shown that today the long-term results of the use of the above-indicated method remain most problematic. Complications that occur in the late postoperative period and are determined by the surgical procedure of distant transluminal aortic grafting may present a real threat to the patient's health and life and require repeat surgical intervention. Analysis of the potential causes of the late complications evidences that undesirable complications cannot be always prevented only by refinement of the design and properties of vascular endografts employed. The study of additional circumstances which are likely to influence the surgical outcomes is carried out on an ever broader scale. The present paper analyzes the scientific literature and provides the data of the author's own experimental study in order to describe an adverse role which is played in all probability by arterial hypertension with respect to the outcomes of distant transluminal aortic grafting.

Impact of the volume of aneurysmal contents on intraaneurysmal pressure after endovascular grafting (experimental studies).

With the purpose of clarifying the nature and outlining certain constituents of such an undesirable condition designated as "endotension", that emerges after transluminal grafting of the aneurysmally changed aorta, a basic theoretical model was worked out for explanation of "endotension". Also, there was designed and constructed in vitro an original experimental model using which the authors carried out a study into the relationship between the pressure in the aneurysm after its complete exclusion from the blood flow by an endovascular graft and the volume of the aneurysmal contents. Some factors described in the literature as influencing the pressure level in the aneurysm were at the given stage purposefully excluded. The volume of the "aneurysm" reproduced in our model was equal to 675 ml; each of five vascular grafts implanted into the aneurysm measured 110 mm in length. The pulsating liquid flow was reproduced in the system using a serial appliance for extracorporeal circulation. The liquid was aspirated from the aneurysm by means of a syringe with concurrent pressure guidance in the sac. To start pressure lowering, it was necessary to evacuate 0.4-1.6 ml of the liquid. The real clinical situations were considered from the standpoint of our results.