Bokeriia L A, Arakelian V S, Zhane A K, Papitashvili V G, Siradze I V
Angiol Sosud Khir. 2012;18(2):107-15.
Analysed herein are the results of treating a total of 471 patients operated on at the Department of Surgical Treatment for Arterial Pathology of the Research Centre of Cardiovascular Surgery named after A. N. Bakulev under the Russian Academy of Medical Sciences for an aneurysm of the infrarenal portion of the abdominal aorta. Complicated forms of AAA were observed in 71 (15.1%) patients. Of these, 13 patients were admitted presenting with a clinical picture of aortic rupture, 56 patients with aortic wall tear (according to ultrasound and/or MSCH findings), and two patients had break of the inferior vena cava. The most frequently encountered accompanying diseases were as follows: CAD noted in 367 (78.2%) patients. Valvular heart defects were revealed in 68 (14.4%) patients. Atherosclerotic alterations of the ascending aorta were diagnosed in 97 (20.6%) patients, and an ascending aortic aneurysm in 14 (2.8%) patients. Operations on the heart were performed in 45 (19.1%) patients. Mitral valve plasty was carried out in 7 patients, and 11 patients had a history of prior interventions on the aortic root and ascending aorta (Bentall-De Bono operation in 3 patients, Carbol operation in 3 patients). 32 patients underwent reconstructive operations on coronary arteries. Transmyocardial laser revascularization of the myocardium was carried out in 4 patients. Endovascular interventions were performed in 32 (6.8%) patients (stenting or transluminal balloon angioplasty of coronary arteries). All patients underwent AAA resection with prosthetic repair. The mentioned operations were combined with the following simultaneous interventions: aortocoronary bypass grafting performed in 31 cases, carotid endarterectomy in 27 cases, and plasty of renal arteries was carried out in 48 patients. Complications in the immediate postoperative period were observed in 79 (16.8%) patients. Hospital mortality amounted to 11 (2.3%) patients. The cumulative survival rate after 1, 5 and 10 years after surgery amounted to 93%, 81% and 44%, respectively, in a complicated course amounting to 91%, 79% and 16%, respectively. The obtained findings of the study demonstrated that the results of the AAA resection should be regarded as fairly good. The main factors influencing the quality of life and surgical outcomes in abdominal aortic aneurysms are as follows: CAD, arterial hypertension, and chronic cerebrovascular diseases. In patients without accompanying diseases, the criteria of quality of life after surgery approximate to those in a healthy population.
本文分析了俄罗斯医学科学院以A. N. 巴库列夫命名的心血管外科研究中心外科治疗动脉疾病科对471例腹主动脉肾下段动脉瘤患者进行手术治疗的结果。71例（15.1%）患者观察到复杂形式的腹主动脉瘤。其中，13例患者入院时表现为主动脉破裂的临床症状，56例患者有主动脉壁撕裂（根据超声和/或多层螺旋CT血管造影结果），2例患者下腔静脉破裂。最常见的伴随疾病如下：367例（78.2%）患者有冠心病。68例（14.4%）患者发现瓣膜性心脏病。97例（20.6%）患者诊断为升主动脉粥样硬化改变，14例（2.8%）患者有升主动脉瘤。45例（19.1%）患者进行了心脏手术。7例患者进行了二尖瓣成形术，11例患者有主动脉根部和升主动脉先前干预史（3例患者进行了Bentall-De Bono手术，3例患者进行了Carbol手术）。32例患者接受了冠状动脉重建手术。4例患者进行了心肌激光血运重建术。32例（6.8%）患者进行了血管内介入治疗（冠状动脉支架置入或腔内球囊血管成形术）。所有患者均接受了腹主动脉瘤切除及人工血管修复术。上述手术同时合并以下干预措施：31例患者进行了主动脉冠状动脉搭桥术，27例患者进行了颈动脉内膜切除术，48例患者进行了肾动脉成形术。79例（16.8%）患者在术后即刻观察到并发症。住院死亡率为11例（2.3%）。术后1年、5年和10年的累积生存率分别为93%、81%和44%，复杂病程分别为91%、79%和16%。该研究获得的结果表明，腹主动脉瘤切除的结果应被视为相当良好。影响腹主动脉瘤患者生活质量和手术结果的主要因素如下：冠心病、动脉高血压和慢性脑血管疾病。在无伴随疾病的患者中，术后生活质量标准接近健康人群。
