[Open surgical treatment of aneurysms and dissection of the thoracic and thoracoabdominal aorta]. / Otkrytoe khirurgicheskoe lechenie anevrizm i rassloeniia grudnoi i torakoabdominal'noi aorty.

Presented herein is experience in treating a total of 56 patients with pathology of the arch, descending and thoracoabdominal aorta from 1997 to 2017. Of these, 6 (11%) patients were diagnosed with a Crawford type I-II thoracoabdominal aortic aneurysm (TAAA), 20 (35%) patients with Crawford type III-IV TAAA, 18 (32%) were diagnosed as having an aortic arch aneurysm (AAA) and descending thoracic aortic aneurysm (DTAA), 12 (22%) had DeBakey type I and IIIb aortic dissection. To protect the visceral organs and spinal cord from ischaemia in 28 (50%) cases we used a temporal bypass from a synthetic vascular graft with zero porosity and measuring from 15 to 20 cm in diameter. RESULTS: Mortality within 30 days amounted to 14.3% (n=8), that after 30 days amounted to 10.7% (n=6): in elective operations - 12% (n=5) and 5.4% (n=3), in emergency operations - 21% (n=3) and 21.4% (n=3), respectively. The total in-hospital mortality amounted to 25% (n=14), equalling 19% (n=8) and 43% (n=6) for elective and emergency operations, respectively. Mortality in using temporal bypass in elective operation amounted to 9.5% (n=2) during 30 days and that without using this method to 14.3% (n=3), after 30 days being 9.5% (n=2) and 4.7% (n=1), respectively. Mortality for emergency cases with a temporal shunt during 30 days was 28.6% (n=2), without - 14.3% (n=1), after 30 days - 28.6% (n=2), without - 14.3% (n=1). In type I-II TAAA mortality within 30 days was 16.6% (n=1), after 30 days - 50% (n=2); type III-IV TAAA - 10% (n=2) and 15% (n=1); DTAA - 22.2% (n=4) and 33.3% (n=2); aortic dissection - 8.3% (n=1) and 16.6% (n=1). Acute renal failure (ARF) occurred in 6 (10.7%) patients and was more often observed in the group without temporal shunting. Events of spinal cord ischaemia with the development of spinal stroke occurred in 6 (10.7%) cases. Five-year survival amounted to 61%. CONCLUSION: Temporal bypass in surgery of the thoracic and thoracoabdominal aorta may be used for prevention of ischaemia of visceral organs, kidneys and spinal cord in operations accompanied by cross-clamping of the descending thoracic aorta.

[Results of a single-centre study of open and endovascular operations of prosthetic repair of abdominal aortic aneurysms]. / Rezul'taty odnotsentrovogo issledovaniia otkrytykh i éndovaskuliarnykh operatsii protezirovaniia anevrizm briushnogo otdela aorty.

OBJECTIVE: The purpose of the study was to assess surgical outcomes in patients suffering from an infrarenal abdominal aortic aneurysm and treated at the Department of Cardiovascular Surgery #2 of the National Medical Research Centre named after V.A. Almazov. PATIENTS AND METHODS: We carried out a non-randomized retrospective study including a total of 209 patients presenting with an infrarenal abdominal aortic aneurysm. Of these, 160 (76%) patients were subjected to open surgical interventions (Group One) and 49 (24%) patients underwent endovascular isolation of the abdominal aortic aneurysm (Group Two). The check examination was performed in the early postoperative period and at 30 postoperative days. The mean age of the patients amounted to 65±3.4 and 69±6.2 years in Group One and Two, respectively, with the mean diameter of the infrarenal portion of the aorta amounting to 6.5±0.8 and 6.7±0.9 cm, respectively. RESULTS: 30-day mortality amounted to 2.5 and 2.05% in Group One and Two, respectively (OR 1.231; 95% CI 0.134-11.277). Repeat interventions were more often performed in Group One patients compared with Group Two patients (13.7 vs 2.05%) (OR 6.085; 95% CI 0.791-46.799). Postoperative complications were observed more often in Group One patients than in Group Two patients (OR 9.916; 95% CI 2.143-39.457). Complications encountered in Group One and not observed in Group Two were as follows: nosocomial pneumonia - in 3.75% of cases, acute impairment of cerebral circulation (AICC) and acute myocardial infarction - in 1.25% of cases each, cardiac arrhythmia and acute renal failure - in 1.88% of cases each. Local postoperative wound-related complications were encountered in 18.11% of cases in Group One versus 4.1% in Group Two (OR 5.202; 95% CI 1.195-22.652). CONCLUSIONS: The retrospective analysis of open and endovascular methods of treatment of abdominal aortic aneurysms demonstrated that, given the multifocal nature of an atherosclerotic lesion in the cohort of patients involved, it is appropriate in the preoperative period to perform coronarography in all patients in order to rule out significant damage of the coronary bed. It is also appropriate to regard a cohort over 60 years and patients found to have significant concomitant pathology as candidates for endovascular treatment. A differentiated approach to careful selection will make it possible to improve the results of treatment of abdominal aortic aneurysms.

[Hybrid treatment of patients with aneurysms and dissections of the aortic arch and descending portion of the thoracic aorta]. / Gibridnoe lechenie bol'nykh s anevrizmami i rassloeniiami dugi i niskhodiashchego otdela grudnoi aorty.

The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52.5%), and total debranching (n=1; 4.7%). The second stage consisted in implantation of a stent graft: to the thoracic aorta in 18 (85.8%) cases, and to the thoracic and abdominal portions of the aorta in 3 (14.2%) cases. The most significant complications of the immediate postoperative period included acute cerebral circulation impairment (n=1) and local dissection of the ascending aorta (n=1). Type I endoleaks were observed in 4 (19%) patients, type II endoleaks in 1 (4.7%), and type III endoleaks in 1 (4.7%). The mean duration of the follow up after discharge from hospital amounted to 11.6±7.9 months. In 4 patients after 6 months the findings of the control MSCT angiography showed no significant changes of the endoleaks. 1-year patency of the shunted branches of the aortic arch amounted to 95.2%. The cumulative survival rate amounted to 95.2%.

[Successful two-stage surgical treatment of a thoracoabdominal aortic aneurysm: a case report]. / Sluchai uspeshnogo dvukhétapnogo khirurgicheskogo lecheniia torakoabdominal'noi anevrizmy aorty.

Presented herein is a clinical case report regarding hybrid or two-stage surgical treatment of a Crawford type II thoracoabdominal aortic aneurysm in an 87-year-old woman. For the first stage operation we performed open resection of the abdominal aortic aneurysm with aortofemoral bifurcation prosthetic repair and debranching of visceral and renal arteries. Several months thereafter, the second stage operation was performed, consisting in transcatheter exclusion of the thoracoabdominal aortic aneurysm with the help of two stent grafts. The postoperative period turned out uneventful, with no complications. The check-up contrast-enhanced multislice computed tomography (MSCT) carried out 8 months later showed neither endoleaks nor migration of the stent grafts, with the bypass shunts' patency preserved.