A growing number of specialists are now beginning to ascertain that treatment of individuals with
descending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled
basis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development
of conservative treatments and elaboration of indications for surgery. A total of 97 patients with
thoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have
been examined over a 5-year period. They received multifaceted anti-inflammatory medical
treatment to strengthen the aortic wall and control its possible expansion. Operative treatment
was offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting
mortality is the presence of co-morbidities requiring permanent medical corrective treatment
irrespective of surgical or medical treatment provided. It is also important to outline the indications
for surgery based on multifactorial pathogenetic manifestations. Treatment aiming at
the reversal of ethiopathogenic mechanisms of disease progression contributes to a significant
longer survival in DAA patients.
References
[1]
Shirinbek, О. and Bakulev, A.N. (2008) Infrarenal Abdominal Aneurisms: Modalities and Outcomes (Literature Review). Cardiovascular Disease Journal, RAMN (Russian Academy of Medical Sciences), 9, 50-57. (in Russian)
[2]
Hallett Jr., J.W. (1992) Abdominal Aortic Aneurysm: Natural History and Treatment. Heart Disease and Stroke, 1, 303-308.
[3]
Bokeria, L.А., Arakelyan, V.S. and Bakulev, A.N. (2010) Aortic Segment Thoracic and Thoracic Abdominal Aneurism Surgery: Guidelines for Practitioners. RAMN (Russian Academy of Medical Sciences), 394. (In Russian)
[4]
ESC Guidelines (Committee for Practice Guidelines to Improve the Quality of Clinical Practice and Patient Care in Europe). www.escardio.by
[5]
Restrepo, C.S., Jcazionez, D., Suri, R. and Vargas, D. (2011) Аortitis: Imaging Spectrum of the Infectious and Inflammatory Conditions of the Aorta. Radiographics, 31, 435-451.
[6]
Harrington, D.J. (1996) Bacterial Collagenases and Collagen-Degrading Enzymes and Their Potential Role in Human Disease. Infection and Immunity, 64, 1885-1891.
Boersmа, E., Kertai, M.D., Schouten, O., et al. (2005) Perioperative Cardiovascular Mortality in Noncardiac Surgery: Validation of the Lee Cardiac Risk Index. The American Journal of Medicine, 118, 1134-1141. http://dx.doi.org/10.1016/j.amjmed.2005.01.064
[9]
Greenhalgh, R.M., Brown, L.C., Kwong, G.P., et al. (2004) EVAR Trial Participants. Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1), 30-Day Operative Mortality Results: Randomized Controlled Trial. The Lancet, 364, 843-848.
[10]
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.
[11]
John, K.А., Lusher Thomas, F. and Serruys Patrick, W. (2011) Cardiovascular Diseases. ECS Guidelines. “GEOTAR- Media”, С, 1209-1248. (Translated into Russian)
[12]
Jeffrey, A.J. Spinale, F.G. and Ikonomidis, J.S. (2009) Transforming Growth Factor-Beta Signaling in Thoracic Aortic Aneurysm Development: A Paradox in Pathogenesis. Journal of Vascular Research, 46, 19-37.
[13]
Yoshimura, K. and Aoki, H. (2012) Recent Advances in Pharmacotherapy Development for Abdominal Aortic Aneurysm. International Journal of Vascular Medicine, 2012, 648167.
[14]
Mikhaylov, D.V., Vinokurov, I.А., Bogopolskaya, О.М., et al. (2012) Perspectives of Preventive Treatment of Large Vessel Aneurysms. Kardiologiya i sedechnososudistaya khirurgiya, 4, 51-56.
[15]
Cherepakhin, D.I., Bazilev, V.V., Evtyushkin, I.L., et al. (2012) Large Vessel Aneurysms in the Era of Genomics and Proteomics and Prognostic Medicine Options. Kardiologiya i sedechnososudistaya khirurgiya, 4, 58-62.
[16]
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 Aneurism Treatment. Health, 6, 1345-1351. http://dx.doi.org/10.4236/health.2014.612165
[17]
Krylov, V.P., Titov, L.P., Gayduk, V.N., Reut, L.I., Smаliakou, A.L. and Mankevich, N.V. (2015) Atherosclerotic Descending Aortic Aneurysm. Pros and Cons of Surgery. World Journal of Cardiovascular Surgery, 5, 91-101. http://dx.doi.org/10.4236/wjcs.2015.59015
[18]
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.
[19]
Mankevich, N.V., Mrochek, А.G., Krilov, V.P., Gayuduk, V.N., Reut, L.I. and Smoliakou, А.L. (2015) Predictors of Progression of Atherosclerotic Descending Aortic Aneurysm and Correction. Kardiologiya v Belarusi, 5, 63-73.
[20]
Yoshimura, K., Aoki, H., Ikeda, Y., Furutani, A., Hamano, K. and Matsuzaki, M. (2006) Regression of Abdominal Aortic Aneurysm by Inhibition of c-Jun N-Terminal Kinase in Mice. Annals of the New York Academy of Sciences, 1085, 74-81.