Descending aortic aneurysms (DAAs), including dissecting aneurysms (DA) have a multifactorial etiology and pathogenesis, therefore raising questions about the leading role of operative treatment to repair the lesion. Objective: To investigate remote (7 and more years) results of treatment in patients with DAAs in operative treatment only if there is a danger of aneurysm rupture. A total of 82 patients with atherosclerotic DAA identified between 2008 and 2011, and 22 patients with type 1 or 3 DeBakey dissecting aneurysms (DA) who had not been operated in the acute period due to a number of reasons were examined. The follow-up period of these groups was 7 or more years. When using a sparing treatment to treat DAA, we saw survival of 90.1 at 2 years, 76.8% at 4 years, 59.4% at 6 years, and 57.5% at 7 years with the uniform increase in mortality rate, mainly due to a comorbidity. Survival in DA group (77.3%) was better due to a younger age and was 68.4% in operated and 54% in non-operated patients at 7 years. It is symptomatic that the aneurysm rupture rate was not always affected by operative treatment. Therefore, it seems like medical treatment is more consistent with etiopathogenesis of the disease compared to surgery during the stabilization period.
References
[1]
Shirinbek, О. (2008) Infrarenal Abdominal Aneurisms: Modalities and Outcomes (Literature Review). Cardiovascular Disease Journal, 9, 50-57. (In Russian)
[2]
Dua, M.M. and Dalman, R.L. (2010) Hemodynamic Influences on Abdominal Aortic Aneurism Disease. Application of Biomechanics to Aneurysm Pathophysiology. Vascular Pharmacology, 53, 11-21. https://doi.org/10.1016/j.vph.2010.03.004
[3]
Aggarwal, S., Qamar, A., Sharma, V. and Sharma, A. (2011) Abdominal Aortic Aneurysm: A Comprehensive Review. Experimental & Clinical Cardiology, 16, 11-15.
[4]
Fleming, C., Whitlock, E.P., Beil, T.L., et al. (2005) Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review for the US Preventive Services Task Force. Annals of Internal Medicine, 142, 203-211.
https://doi.org/10.7326/0003-4819-142-3-200502010-00012
[5]
John, K.А., Thomas, L.F. and Serrius Patrick, V. (2011) Cardiovascular Disease Edition. “ESC Guidelines” GEOTAR-Media, 1209-1248. (In Russian)
[6]
Сapri, M., Salvioli, S., Sevini, F., et al. (2006) The Genetics of Human Longevity. Annals of the New York Academy of Sciences, 1067, 252-263.
https://doi.org/10.1196/annals.1354.033
[7]
Wang, M., Zhang, J., Jiang, L.Q., et al. (2007) Pro-Inflammatory Profile within the Grossly Normal Aged Human Aortic Wall. Hypertension, 50, 219-227.
https://doi.org/10.1161/HYPERTENSIONAHA.107.089409
[8]
Venugopal, S.K., Devaraj, S., Yuhanna, I., Shaul, P. and Jialal, I. (2002) Demonstration that C-Reactive Protein Decreases eNOS Expression and Bioactivity in Human Aortic Endothelial Cells. Circulation, 106, 1439-1441.
https://doi.org/10.1161/01.CIR.0000033116.22237.F9
[9]
Wang, M., Zhang, J., Spinetti, G., et al. (2005) Angiotensin II Activates Matrix Metalloproteinase Type II and Mimics Age-Associated Carotid Arterial Remodeling in Young Rats. The American Journal of Pathology, 167, 1429-1442.
https://doi.org/10.1016/S0002-9440(10)61229-1
[10]
Lim, M.A. and Townsend, R.R. (2009) Arterial Compliance in the Elderly: Its Effect on Blood Pressure Measurement and Cardiovascular Outcomes. Clinics in Geriatric Medicine, 25, 191-205. https://doi.org/10.1016/j.cger.2009.01.001
[11]
Boersmа, E., Kertai, M.D., Schouten, O., et al. (2005) Perioperative Cardiovascular Mortality in Non-Cardiac Surgery: Validation of the Lee Cardiac Risk Index. The American Journal of Medicine, 118, 1134-1141.
https://doi.org/10.1016/j.amjmed.2005.01.064
[12]
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.
[13]
Williаms, B., Lacy, P.S., Thom, S.М., et al. (2006) for the CAFé investigators. Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes. Principal Results of the Conduit Artery Function Evaluation (CAFé) Study. Circulation, 113, 1213-1225.
https://doi.org/10.1161/CIRCULATIONAHA.105.595496
[14]
Prozorovskaya, N.N., Glinyanaya, S.V., Gerastchenko, L.P., et al. (1988) Impact of Beta-Blocker Therapy and Vitamin Supplements on Oxyproline Secretion in the Context of Heritable Connective Tissue Disorders. Voprosi Meditsinskoy Khimii, 34, 99-104. (In Russian)
[15]
Sudakov, K.V. (2005) Individual Nature of Emotional Stress. Nevrologiya i psikhiatriya, 5, 5-10. (In Russian)
[16]
Ceconi, C., Francolini, G., Bastianon, D., et al. (2007) Differences in the Effect of Angiotensin-Converting Enzyme Inhibitors on the Rate of Endothelial Cell Apoptosis: In Vitro and in Vivo Studies. Cardiovascular Drugs and Therapy, 21, 423-429.
https://doi.org/10.1007/s10557-007-6068-5
[17]
Virdis, A., Ghiadoni, L. and Taddei, S. (2011) Effects of Antihypertensive Treatment on Endothelial Function. Current Hypertension Reports, 13, 276-281.
https://doi.org/10.1007/s11906-011-0207-x
[18]
Manisty, C.H., Zambanini, A., Parker, K.H., et al. (2009) Differences In the Magnitude of Wave Reflection Account for Differential Effects of Amlodipine-Versus Atenolol-Based Regimens on Central Blood Pressure: An Anglo-Scandinavian Cardiac Outcome Trial Sub-Study. Hypertension, 54, 724-730.
https://doi.org/10.1161/HYPERTENSIONAHA.108.125740
[19]
Rothwell, P.M., Howard, S.C., Dolan, E., et al. (2010) Effects of Beta-Blockers and Calcium Channel Blockers on within-Individual Variability in Blood Pressure and Risk of Stroke. The Lancet Neurology, 9, 469-480.
https://doi.org/10.1016/S1474-4422(10)70066-1
[20]
Vammen, S., Lindholt, J.S., Østergaard, L., Fasting, H. and Henneberg, E.W. (2001) Randomized Double Blind Controlled Trial of Roxithromycin for Prevention of Abdominal Aortic Aneurysm Expansion. British Journal of Surgery, 88, 1066-1072.
https://doi.org/10.1046/j.0007-1323.2001.01845.x
[21]
Chernomortseva, E.S., Pokrovsky, M.V., Titaryova, L.V., et al. (2010) A Multifaceted Assessment of Endothelial Protector and Cardioprotector Activity of Macrolide Antimicrobials to Model Nitric Oxide Deficiency. Eksperimentalnaya i Klinicheskaya Farmakologiya, 9, 20-23.
[22]
Ejiri, J., Jnoue, N., Tsucube, T., et al. (2003) Oxidative Stress in Pathogenesis of Thoracic Aortic Aneurysm: Protective Role of Statin And Angiotensin II Type I Receptor Blocker. Cardiovascular Research, 59, 988-996.
https://doi.org/10.1016/S0008-6363(03)00523-6
[23]
Mrochek, A.G. and Gubar, E.N. (2007) Hypercholesterolemia, Statins and the Role of Atorvastatin (LipiMAX®) To Treat Atherosclerosis and Its Complications. Ars Medica, 1, 33-41. (In Russian)
[24]
Taneva, E., Borucki, K. and Wiens, L. (2006) Early Effects on Endothelial Function of Atorvastatin 40 mg Twice Daily and Its Withdrawal. American Journal of Cardiology, 97, 1002-1006. https://doi.org/10.1016/j.amjcard.2005.10.032
[25]
Arakelyan, V.S. and Zhane, А.K. (2012) Coronary Artery Lesion in Patients with Infrarenal Abdominal Aneurysm. Kreativnaya Kardiologiya, 2, 56-66. (In Russian)
[26]
Krylov, V.P., Manak, N.A., Gayduk, V.N., Mankevich, N.V. and Reut, L.I. (2017) Ways to Correct Indications for Surgical Treatment of Atherosclerotic Descending Aortic Aneurysms. Advances in Surgical Sciences, 5, 31-35.
https://doi.org/10.11648/j.ass.20170503.11
[27]
Krylov, V.P., Shevtsov, D.E., Popel, G.A., Zhigalkovich, A.S., et al. (2018) Sparing Treatment of Thoracic and Abdominal Aortic Aneurysms. Health, 10, 458-466.
https://doi.org/10.4236/health.2018.104037
[28]
Schepens, M.A., Kelder, J.C., Morshuis, W.J., et al. (2007) Long-Term Follow-Up after Toracoabdominal Aortic Aneurysm Repair. The Annals of Thoracic Surgery, 83, S851-S855. https://doi.org/10.1016/j.athoracsur.2006.10.087
[29]
Sweeting, M.J., Thompson, S.G., Brown, L.C., Greenhalgh, R.M. and Powell, J.T. (2010) Use of Angiotensin Converting Enzyme Inhibitors Is Associated with Increased Growth Rate of Abdominal Aortic Aneurysms. Journal of Vascular Surgery, 52, 1-4. https://doi.org/10.1016/j.jvs.2010.02.264
[30]
Sweeting, M.J., et al. (2012) Meta-Analysis of Individual Patient Data to Examine Factors Affecting Growth and Rupture of Small Abdominal Aortic Aneurysms. British Journal of Surgery, 99, 655-665. https://doi.org/10.1002/bjs.8707
