Abdominal aortic aneurysms: assessment of surgical treatment and surgically induced complications, analysis of mortality

Abstract


Actuality: Abdominal aortic aneurysm (the ABA) - the most frequent localization of aneurysms of the cardiovascular system - it accounts for around 80% [1].

Objective: to assess the surgical treatment of patients with AAA, consider the complications that have arisen, study the mortality. Materials and Methods: The study of the examination results and the outcomes of surgical treatment of AAA was carried out in 30 inpatients who were operated on in the department of vascular surgery of the Grodno University Clinic. 

Results of the study: all operations were performed exclusively with open access; in all cases, a total midline laparotomy was used. The most frequently performed operation was resection of the aortic aneurysm with aortobifemoral prosthetics - in 27 patients (90%), aortobilial prosthetics was also used - in 1 patient (3.33%), in 1 (3.33%) - aortic ligation in the area of ​​the aneurysm neck and axillobifemoral prosthetics and in 1 (3.33%) aortobifemoral prosthetics with aortic resection to turn off the aneurysm due to long-term organized extensive hematoma. The most frequent postoperative complication was hematoma of the retroperitoneal space - observed in 8 cases (26.67%), ureterohydronephrosis - in 5 patients (16.67%), hydrothorax - in 2 (6.67%), in 2 (6.67%) ) - lumbosacral plexopathy with gross flaccid paresis of the lower limb, in 2 (6.67%) - pneumonia. Postoperative mental disorders were observed in 4 patients (13.33%): in 3 (10%) - delirium not caused by alcohol or other psychoactive substances (F05) and in 1 (3.33%) - mild cognitive disorder (F06.71 ). 7 patients died, all of them were operated urgently for ruptured AAA.

Conclusion: According to the results of the study, it was revealed that the most frequently performed intervention is resection of the aortic aneurysm with aortobifemoral prosthetics. The course of the postoperative period in all patients with elective resection was satisfactory, and in cases of ruptured AAA, there were lethal outcomes. The most common complications were retroperitoneal hematomas, ureterohydronephrosis and postoperative mental disorders (delirium and mild cognitive impairment).


Full Text

Relevance. Abdominal aortic aneurysm (AAA) is a life-threatening condition that requires monitoring or treatment depending on the size of the aneurysm and / or symptoms. The most widely used definition of AAA is aortic dilatation with a diameter of ≥30 mm. Some researchers offer an alternative definition - an increase in the diameter of the vessel> 50%, but this cannot always be determined, especially when the border between the aneurysm and the unaffected area is indistinct [1].
Aneurysm of the abdominal aorta is the most frequent localization of aneurysms of the cardiovascular system - it accounts for about 80% of cases [2].
The urgency of this problem is due to the fact that abdominal aortic aneurysms can exist for a long time without any serious symptoms. At the same time, there is a high risk of various complications. Every year the volume of the aneurysmal sac grows by 10%, as a result of which, without timely treatment, the aneurysm becomes thinning and ruptured [3]. Such clinical situations directly threaten the patient's life in the absence of emergency surgical care. Aortic aneurysm rupture is the tenth leading cause of death from cardiovascular diseases in Western Europe and North America and North America, in the UK and the USA 10-15 thousand people die annually from complications of aortic aneurysm [4].
The frequency of AAA in the population ranges from 0.5% to 3%. At the same time, the study of the prevalence of aneurysms detected by ultrasound (US) was 4.3% in men and 2.1% in women [5]. The annual risk of rupture of an aneurysm with a diameter of 6-7 cm is 10-20%, 7-8 cm - 20-40%, over 8 cm - 30-50%. Aneurysm rupture of more than 6 cm occurs in 27 out of 100 people per year [6].
Operational mortality in elective open surgery for AAA varies significantly between clinics and countries and ranges from 1% to 8%. The results of open surgery for ruptured ABA are much worse than those for elective surgery. In developed countries, the mortality rate of ruptured aneurysmal transformations before hospitalization is up to 40%, and in the postoperative period it reaches 60-70% [7].
Purpose of work. To assess the results of surgical treatment of patients with AAA, to analyze the frequency of postoperative complications, to determine the mortality rate in this pathology.
Materials and methods. A study of the diagnostic results and outcomes of classical surgical resections of abdominal aneurysms in 30 inpatients who were operated on in the Department of Vascular Surgery of the Grodno University Clinic for the last year. All patients are men. The average age was 68.5 ± 1.07 years. In a planned and urgent manner (up to one day), 19 (63.33%) patients were operated on, in 11 (36.67%) clinical cases, surgical treatment was performed urgently, for health reasons due to the complication of the rupture of the dilatation pathological process of the abdominal aorta. The results were processed using methods of nonparametric statistics using the STATISTICA 6.0 analysis package and Excel.
Results. According to A.V. Pokrovsky (1979), 15 patients (50%) had type 2 AAA (infrarenal section without involvement of the bifurcation), in other 15 (50%) - type 3 (aneurysm of the infrarenal segment with involvement of the bifurcation of the aorta and iliac arteries).
The average size of the aneurysm was 68 mm, with the minimum size being 45 mm and the maximum size being 134 mm. Among patients with AAA rupture (11 patients in total), 2 of them (18, 18%) had aneurysm sizes less than 55 mm, 3 (27, 27%) - from 55 mm to 79 mm, and 6 (54.55%) ) patients - from 80 mm. In type 3 AAA, the expansion of the iliac arteries was observed on average up to 49.7 mm (minimum - 22 mm, maximum - 88 mm).
Half of the patients (50%) were operated on as planned, 4 patients (16.67%) required an urgent operation. Also, 11 patients (33.33%) with this pathology were hospitalized and operated urgently: within 6 hours from the onset of complicated clinical manifestations of the disease, 2 patients (18.18%) were hospitalized, within 7 to 24 hours - 2 patients ( 18.18%), over 24 hours - 7 patients (63.64%).
15 patients (50%) had aortic dissection or AAA rupture: in 4 (13.33%), according to ultrasound or tomography, aortic dissection was observed (group of patients operated on for urgent indications), in 7 (23.33%) - ruptured aneurysm, 4 (13.33%) had aortic dissection and ruptured aneurysm. Acute arterial insufficiency of the lower extremities occurred in 3 patients (10%).
All operations were performed only with open access, in all cases a total midline laparotomy was used. The average duration of the operation was 229.2 ± 9.86 minutes.

Among open operations, the most frequently performed was resection of the aortic aneurysm with aortobifemoral prosthetics - in 27 patients (90%), aortobilial prosthetics was also used - in 1 patient (3.33%), in 1 (3.33%) - aortic ligation in the area aneurysm neck and axillobifemoral prosthetics and in 1 (3.33%) aortobifemoral prosthetics with aortic resection to turn off the aneurysm due to long-term organized extensive hematoma. Additionally, in 2 cases (6.66%), the inferior mesenteric artery was implanted into the prosthesis, in 2 (6.66%) - viscerolysis, in 1 (3.33%) - femoropopliteal shunting with a reversed autovein, in 1 (3, 33%) - suturing of dissection of the left lobe of the liver and splenectomy. The most frequent postoperative complication was hematoma of the retroperitoneal space - observed in 8 cases (26.67%), ureterohydronephrosis - in 5 patients (16.67%), hydrothorax - in 2 (6 , 67%), in 2 (6.67%) - lumbosacral plexopathy with severe flaccid paresis of the lower limb, in 2 (6.67%) - pneumonia. Postoperative mental disorders were observed in 4 patients (13.33%): in 3 (10%) - delirium not caused by alcohol or other psychoactive substances (F05) and in 1 (3.33%) - mild cognitive disorder (F06.71 All patients operated on for planned and urgent indications were characterized by a satisfactory course of the postoperative period. They were discharged for outpatient treatment 10-14 days after surgery. 7 patients died, all of them were operated urgently for ruptured AAA. Mortality in the group of urgently operated on for rupture of abdominal aneurysms was 63.64%. Discussion. We assessed the tactics and method of surgical treatment of patients with AAA and the results of operations in this pathology, investigated the incidence of postoperative complications, analyzed the mortality rate in this pathology. However, this study is limited by the boundaries of one health care institution ("Grodno University Clinic") and the time frame, which does not give a complete picture of the scale of this problem. Conclusion. Currently, the traditional surgical correction - aneurysm resection with aorto-femoral aortic prosthetics is still the gold standard. However, open surgery for AAA is associated with a certain risk of mortality and complications. The most common complications are retroperitoneal hematomas, ureterohydronephrosis, and postoperative psychiatric disorders (delirium and mild cognitive impairment). The results of open surgery for ruptured ABA are much worse than those for elective surgery. Mortality in the group of urgently operated on for rupture of abdominal aneurysms was 63.64%. Therefore, patients with this pathology require careful monitoring and timely treatment.

About the authors

Anastasya E. Runge

Grodno State Medical University

Author for correspondence.
Email: runge2000@mail.ru
ORCID iD: 0000-0003-1734-7388

Belarus, Belarus, Grodno, Gorkogo street, 80, 230009

Maryia D. Sharylava

Grodno State Medical University

Email: sharilovamasha1999@gmail.com
ORCID iD: 0000-0002-1118-1404
SPIN-code: 6237-4642

Belarus, Belarus, Grodno, Gorkogo street, 80, 230009

References

  1. Рекомендации ESC по диагностике и лечению заболеваний аорты 2014 [Электронный ре-сурс]. – Режим доступа: https://scardio.ru/content/Guidelines/Recom%20po%20aorte%207_rkj_15.pdf /. – Дата доступа: 24.10.2020
  2. Покровский, А.А. Клиническая ангиология / А.А. Покровский. – Москва: ОАО «Издательство «Медицина», 2004. – 888 с.
  3. Новый подход к лечению аневризмы брюшной аорты [Электронный ресурс]. – Режим доступа: http://www.nauteh-journal.ru/files/efe08fe8-ac4f-4ea7-96c1-187768d3d9ab /. – Дата доступа: 24.10.2020
  4. Аневризма брюшного отдела аорты: взгляд кардиолога и сердечно-сосудистого хирурга [Электронный ресурс]. – Режим доступа: https://www.researchgate.net/publication/338712761_Aneurysm_of_abdominal_aorta_a_view_of_cardiology_and_cardiovascular_surgeon /. – Дата доступа: 24.10.2020
  5. Abdominal aortic aneurysm [Электронный ресурс]. – Режим доступа: https://www.ncbi.nlm.nih.gov/books/NBK470237 /. – Дата доступа: 24.10.2020
  6. Национальные рекомендации по ведению пациентов с аневризмами брюшной аорты [Электронный ресурс]. – Режим доступа: http://www.angiolsurgery.org/recommendations/2013/recommendations_AAA.pdf /. – Дата доступа: 14.11.2020
  7. Аневризма брюшной аорты [Электронный ресурс]. – Режим доступа : https://racvs.ru/clinic/files/2016/abdominal-aortic-aneurysm.pdf /. – Дата доступа : 24.10.2020

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