Abstract
Objective. To determine the surgical technique for coronary artery lesions combined with AAA.
Material and methods. 296 patients with abdominal aortic aneurysms were observed and operated
in the department of surgical treatment of arterial pathology of A. N. Bakulev SCCVS
RAMS between 2000 and 2011. The majority of the patients were of a certain or gerontic age
and had different concomitant pathologies. Preoperative diagnostics was focused on the characteristics,
localization and hemodynamic significance of the lesion.
Results. The study showed that IHD was found practically in all patients - 238 cases (80.4%).
The necessity for «aggressive» detection of IHD and carrying out the coronarography in all
patients with AAA is justified by the high rates for IHD in AAA, influence of cardiac status on
the choice of surgical technique (staged or single-stage correction) and on the results of treatment.
Conclusions. Single-stage surgical interventions on coronary blood pool in AAA must be performed
on strict medical indications when it is impossible to perform a staged surgery (critical
vascular lesion or insufficiency of the corresponding organ).
References
Дуданов И. П. Хирургическое лечение сочетанных атеросклеротических поражений брахиоцефальных артерий и брюшной аорты: автореф. дис. ... д-ра мед. наук., СПб., 1993. 36 с.
Казанчян П. О., Попов В. А. Осложнения в хирургии аневризм брюшной аорты. М.: Изд-во МЭИ, 2002. 304 с.
Покровский А. В., Дан В. Н., Златовчен А. М., Ильин С. А. Влияние кардиального статуса и артериальной гипертензии на результаты хирургического лечения больных с аневризмами брюшной аорты старше 70 лет // Ангиол. и со- суд. хир. 2003. Т. 9, № 1. С. 71-76.
Работников В. С., Алшибая М. М., Вищипанов С. А. и др. Этапные и одномоментные операции реваскуляризации головного мозга и миокарда у больных ишемической болезнью сердца с поражением брахиоцефальных артерий // Анналы хир. 1999. № 6. С. 36-40.
Спиридонов А. А., Тутов Е. Г., Аракелян В. С. Хирургическое лечение аневризм брюшной аорты. М.: НЦССХ им. А. Н. Бакулева РАМН, 2000. 206 с.
Back M. R., Stordahl N., Cuthbertson D. et al. Limitations in the cardiac risk reduction provided by coronary revascularization prior to elective vascular surgery // J. Vasc. Surg. 2002. Vol. 36, 3. P. 644-645.
Blackbourne L. H., Tribble C. G., Langenburg S. E. et al. Optimal timing of abdominal aortic aneurysm repair after coronary revascularization // Ann. Surg. 1994. Vol. 219. P. 693-698.
Chen J. C., Hildebrand H. D., Salvian A. J. et al. Predictors of death in nonruptured and ruptured abdominal aortic aneurysms // J. Vasc. Surg. 1996. Vol. 24, № 4. P. 614-620.
Crawford E. S., Saleh S. A., Babb III J. W. et al. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period // Ann. Surg. 1981. Vol. 193. P. 699-709.
El-Sabrout R. A., Reul G. J., Colley D. A. Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass // Ann. Vasc. Surg. 2002. Vol. 16, № 3. P. 321-330.
Garcia M., Misplerta L. A., Corso P. J. et al. Combined coronary artery bypass graft and abdominal aortic aneurysmectomy //J. Heart Surg. 1983. Vol. 10, № 2. P. 125-130
Garofalo M., Nardi P., Borioni R. et al. The impact of coronary revascularization on long-term outcomes after surgical repair of abdominal aortic aneurysm // Ital. Heart J. 2005. Vol. 6, № 6. P. 369-374.
Rinckenbach S., Hassani O., Thaveau F. et al. Current outcome of abdominal aortic aneurysm repair // Ann. Vasc. Surg. 2004. Vol. 18, № 6. P. 704-709.
Roger V. L., Ballard D. J., Hallet J. W. Jr et al. Influence of coronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: a population-based study, 1971-1987 // J. Am. Coll. Cardiol. 1989. Vol. 14. P. 1245-1252.
