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Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery

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DOI: 10.4236/wjcs.2015.59015    3,652 Downloads   4,208 Views   Citations

ABSTRACT

Within the last few years, there has been a strong trend to rethink the issue of management of atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic associations among changes observed during the progression of the disease were not fully described, surgeons had successfully applied, although traumatic, but a rather radical method to rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes, mostly concerned mortality, we realized that surgery could not be the main tactical approach to AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required more sparing treatment strategies. The situation gave rise to a more argumentative and sparing medical-and-surgical approach to treatment based on a more in-depth understanding of the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate. The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial determination of indications for surgical correction with outlining the area of relative and absolute risk of aneurysm rupture; 2) Method of conservative treatment aimed to attain and maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease and control co-morbidities. A four-year follow-up of patients using this developed technology has yielded more preferred results suggesting the need for narrowing indications for surgery to treat AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations and implantations of stent-grafts, considering the fact that medical treatment should be used in operated subjects, too.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Krylov, V. , Titov, L. , Gaiduk, V. , Reut, L. , Smaliakou, А. and Mankevich, N. (2015) Atherosclerotic Descending Aortic Aneurysms. Pros and Cons of Surgery. World Journal of Cardiovascular Surgery, 5, 91-101. doi: 10.4236/wjcs.2015.59015.

References

[1] National Russian Abdominal Aortic Aneurysm Management in Adults Guidelines (2011) National Russian Abdominal Aortic and Lower Axtremity Aneurysm Management in Adults Guidelines: Russian Consensus Paper. Bakulev RCCVS RAMN, Moscow, 140.
[2] Chervyakov, Y.V. and Smurov, S.Y. (2011) Management to Treat Abdominal Aorta. Grekov vestnik Khirurgii, 170, 57-61.
[3] Bokeria, L.А. and Arakelyan, V.S. (2010) Surgery to Treat Thoracic and Thoracoabdominal Aortic Aneurysms: Doctors Handbook. Bakulev RCCVS RAMN, Moscow, 394.
[4] Zakhariev, T., еt al. (2001) Combined Surgical Treatment of Patients with Multifocal Atherosclerosis. Khirurgiia, 57, 14-23.
[5] Belov, Y.V. and Komarov, R.N. (2010) Our Failures and Methods to Reduce In-Hospital Mortality Rates in Operative Treatment of Thoracoabdominal Aortic Aneurysms. Angiology and Vascular Surgery, 1, 105-112.
[6] Shirinbek, О. (2008) Infrarenal Aneurysms of Abdominal Aorta: Current Management and Outcomes (Literature Review) in Russian. Cardiovascular Diseases: Bakulev RCCVS RAMN Bulletin, 9, 50-57.
[7] Belov, Y.V., Komarov, R.N., Stepanenko, А.B., Gens, А.P., et al. (2008) Step-by-Step Management of Aortic Aneurysms. Khirurgiya, 3, 17-24. http://www.mediasphera.ru/journals/pirogov/detail/409/6025/
[8] Krylov, V.P., Mrochek, A.G., Titov, L.P., Gaiduk, V.N., Reut, L.I. and Smaliakou, A.L. (2014) Can We Change a Look at Atherosclerotic Aortic Aneurysm Treatment? Health, 6, 1345-1351.
[9] Krylov, V.P., Gaiduk, V.N., Yanushko V.А., Reut L.I., Mankevich, N.V., Smaliakou, A.L, Mikhnevich V.B. and Dergachyova I.М. (2014) Ways to Improve Therapeutic Efficacy in Patients with Atherosclerotic Descending Aortic Aneurysms. Cardiologia v Belarusi, 33, 5-16.
[10] Lederle, F.A., Wilson, S.E., Johnson, G.R., et al. (2002) Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysm. The New England Journal of Medicine, 346, 1437-1444.
[11] EVAR Trial Participants (2005) Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1): Randomized Controlled Trial. The Lancet, 365, 2179-2186.
http://www.ncbi.nlm.nih.gov/pubmed/15978925
[12] EVAR Trial Participants (2005) Endovascular Aneurysm Repair and Outcome in Patients Unfit for Open Repair of Abdominal Aortic Aneurysm (EVAR Trial 2): Randomized Controlled Trial. The Lancet, 365, 2187-2192.
https://ueaeprints.uea.ac.uk/14186/
http://dx.doi.org/10.1016/S0140-6736(05)66628-7
[13] Isselbacher, E.M. (2005) Thoracic and Abdominal Aortic Aneurysms. Circulation, 111, 816-828.
http://circ.ahajournals.org/content/111/6/816.full
http://dx.doi.org/10.1161/01.CIR.0000154569.08857.7A
[14] Mikhailov, D.V., Vinokurov, I.А., Bogopolskaya, О.М., et al. (2011) Perspectives of Preventive Treatment of Aneurysms of Large Vessels. Cardiologia i serdechnososudistaya khirurgiya, 1, 51-56.
http://www.mediasphera.ru/uppic/Cardsurg/2011/1/10/KSS_2011_01_51.pdf
[15] Cherepakhin, D.I., Bazilev, V.V., Evtyushkin, I.L., et al. (2012) Aneurysms of Large Vessels in the Era of Genomics and Proteomics, and Options of Prognostic Medicine. Cardiologia i serdechnososudistaya khirurgiya, 5, 58-62. http://www.mediasphera.ru/journals/cardsurg/detail/874/14140/
[16] Nikonenko, А.А. and Trylin, А.V. (2013) The Role of Cyclophilin А in Pathogenesis of Abdominal Aortic Aneurysm. Cardiologia i serdechnososudistaya khirurgiya, 6, 39-42.
http://www.mediasphera.ru/journals/cardsurg/detail/1100/17821/
[17] Martinov, А.I., Gudilin, V.А., Drokina, О.V., et al. (2015) Endothelial Dysfunction in Patients with Connective Tissue Dysplasia. Lechaschiy vrach, 2, 18-21. http://www.lvrach.ru/2015/02/15436157/
[18] Kasashima, S. and Zen, Y. (2011) IgG4-Related Inflammatory Aortic Aneurysm. Current Opinion in Rheumatology, 23, 18-23.
http://dx.doi.org/10.1097/BOR.0b013e32833ee95f
http://journals.lww.com/co-rheumatology/Abstract/2011/01000/IgG4_related_inflammatory_abdominal_aortic.5.aspx
[19] Ghiglotti, G., Barisione, C., Garibaldi, S., Brunellei, C., Palmieri, D., Spinella, G., Reme B., Spallarosa, P., Alieri, P., Fabei, P., Sambuceti, G. and Palombo, D. (2013) CD16+ Monocytes Subsets and Increased in Large AAA and Are Differently Related with Circulating and Cell-Associated Biochemical and Inflammatory Biomarkers. Disease Markers, 34, 131-142. http://dx.doi.org/10.1155/2013/836849
[20] Samadzadeh, K., Chun, K., Nguyen, A., Baker, P., Bains, S. and Lee, E. (2014) Monocytes Activity Is Linked with Abdominal Aortic Aneurysms Diameter. Journal of Surgical Research, 190, 328-334.
http://dx.doi.org/10.1016/j.jss.2014.03.019
[21] He, A. and Shi, G. (2015) Mast Cells Tryptase as Targets for Cardiovascular and Methabolic Diseases. Current Pharmaceutical Design, 19, 1114-1125.
[22] Lv, B.-J., Li, J.Y. and Cheng, X. (2014) T-Lymphocytes and Aortic Aneurysms. Life Science, 57, 795-801.
http://dx.doi.org/10.1007/s11427-014-4699-x
[23] Jevallee, H., Tang, T. and Cheng, X. (2011) Regulatory T-Cells and Cardiovascular Diseases. North American Journal of Medicine and Science, 4, 178-182. http://dx.doi.org/10.7156/v4i4p178
[24] Wang, J., Chen, J., Chen, C., Huang, S., Rao, X. and Zhong, J. (2012) Elevated Th17 and IL23 in Hypertensive Patients with Acutly Increased Blood Pressure. American Journal of Immunology, 8, 27-32.
http://dx.doi.org/10.3844/ajisp.2012.27.32
http://thescipub.com/PDF/ajisp.2012.27.32.pdf
[25] Liao, M., Liu, C., Ly, B., Zhang, J., Cheng, L., Cheng, X., Lindhole, J., Rassmussen, L. and Shi, G. (2015) Plasma Cytokine Levels and Risks of AAA: A Population Based Prospective Cohort Study. Annals of Medicine, 47, 245-252. http://informahealthcare.com/doi/abs/10.3109/07853890.2015.1019916
[26] Lindholt, L. and Shi, G. (2006) Chronic Inflammation, Immune Response and Infection in AAA. European Journal of Vascular and Endovascular Surgery, 31, 453-463.
http://dx.doi.org/10.1016/j.ejvs.2005.10.030
http://www.sciencedirect.com/science/article/pii/S1078588405006994
[27] Ramaswamy, A., Hamilton, M., Joshi, R., Kline, B., Li, R., Wang, P. and Goergen, C. (2013) Molecular Imaging of Experimental Abdominal Aortic Aneurysms. The Scientific World Journal, 2013, 1-18.
http://dx.doi.org/10.1155/2013/973150
[28] Plavinsky, S.L. (2005) Planning, Processing and Reporting of the Results Obtained from Biomedical Studies Using SAS. Biostatistika, SPb MAPO, 559. (In Russian)
[29] Kemma, А., John, Thomas, L.F. and Serrius Patrick, V. (2011) Cardiovascular Disease Edition. “ESC Guidelines” GEOTAR-Media, 1209-1248. (In Russian)
[30] Allaire, E., Schneider, F., Saucy, F., Dai, J., Cochennec, F., Michineau, S., Zidi, M., Becquemin, J.P., Kirsch, M. and Gervais, M. (2009) New Insight in Aetiopathogenesis of Aortic Diseases. European Journal of Vascular and Endovascular Surgery, 37, 531-537. http://dx.doi.org/10.1016/j.ejvs.2009.02.002
[31] Kazi, M., Thyberg, J., Religa, P., et al. (2003) Influence of Intraluminal Thrombus on Structural and Cellular Composition of Abdominal Aortic Aneurysm Wall. Journal of Vascular Surgery, 38, 1283-1292.
http://www.jvascsurg.org/article/S0741-5214(03)00791-2/abstract
http://dx.doi.org/10.1016/S0741-5214(03)00791-2
[32] Bombeli, T., Karsan, A., Tait, J.F. and Harlan, J.M. (1997) Apoptotic Vascular Endothelial Cells Become Procoagulant. Blood, 89, 2429-2442. http://www.ncbi.nlm.nih.gov/pubmed/9116287
[33] Yoder, M. (2010) Is Endothelium the Origin of Endothelial Projenitor Cells? Arteriosclerosis, Thrombosis, and Vascular Biology, 30, 1094-1103. http://atvb.ahajournals.org/content/30/6/1094.full
[34] Yamawaki-Ogata, A., Hashizume, R., Fu, X.-M., Usai, A. and Narita, Y. (2014) Mesenchymal Stem Cells for Treatment of Aortic Aneurysms. World Journal Stem Cells, 6, 278-287.
http://dx.doi.org/10.4252/wjsc.v6.i3.278
[35] Tian, X., Fan, J., Yu, M., Zhao, Y., Fang, Y., Bai, S., Hou, W. and Tong, H. (2014) Adipose Stem Cells Promote Smooth Muscle Cells to Secrete Elastin in Rat AAA. PLoS ONE, 9, e108105.
http://journals.plos.org/plosone/article?id = 10.1371/journal.pone.0108105
[36] Newberger, J.W., Takahashi, M., Gerber, M.A., Gewitz, M.H., Tani, L.Y., et al. (2004) Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. Circulation, 110, 2747-2771.
http://dx.doi.org/10.1161/01.CIR.0000145143.19711.78
http://www.ncbi.nlm.nih.gov/pubmed/15505111
[37] Hertzer, N.R., Young, J.R., Beven, E.G., et al. (1987) Late Results of Coronary Bypass in Patients with Infrarenal Aortic Aneurysm. Annals of Surgery, 205, 360-367.
http://dx.doi.org/10.1097/00000658-198704000-00004
http://www.scopus.com/record/display.url?eid=2-s2.0-0023254629&origin=inward&txGid=926C4CA9CC751DF3D3AB15B309886228.iqs8TDG0Wy6BURhzD3nFA%3a7
[38] Nikolsky, E. and Mehran, R. (2004) Impact of Symptomatic Peripheral Arterial Disease on 1-Year Mortality in Patients Undergoing Percutaneous Coronary Interventions. Journal of Endovascular Therapy, 11, 60-70.
http://www.ncbi.nlm.nih.gov/pubmed/14748627
http://dx.doi.org/10.1177/152660280401100108
[39] Paul, E.N. and Eikelboom, J.W. (2004) Peripheral Arterial Disease: Prognostic Significance and Prevention of Atherothrombotic Complications. Medical Journal of Australia, 181, 150-154.
https://www.mja.com.au/system/files/issues/181_03_020804/nor10045_fm.pdf

  
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