The Optimization of Surgical Management of Abdominal Aortic Aneurysms Combined with Coronary Heart Disease

The aim of the investigation was to develop an optimal approach enabling to improve the results of surgical management of abdominal aortic aneurysms combined with coronary heart disease.

Materials and Methods. We analyzed prospectively and retrospectively the results of surgical management of 203 patients operated for abdominal aortic aneurysm, including 173 male and 30 female patients. Mean age was 65.20±9.26 years. 133 patients (65.7%) were found to have coronary heart disease (CHD). Noncomplicated aneurysms were revealed in 121 patients (59.6%), among them 71 (58.7%) had CHD, 82 (40.4%) patients had complicated aneurysms including 62 (75.6%) with CHD.

The surgical treatment modality was determined due to clinical progression of the disease and diagnostic findings. We used a single-stage coronary and abdominal aortic pathology correction, and two-stage correction with primary coronary correction and isolated correction of abdominal aortic pathology.

Results. 30 of 203 patients had lethal outcomes, among them there were 24 cases with complicated aneurysm, 6 — with noncomplicated aneurysm. In 24 cases (77.4%) the death was caused by acute cardiovascular insufficiency due to massive blood loss in 15 (48.4%) patients and myocardial infarction — in 9 (29%). In 4 patients the death was caused by acute renal failure, in one — gastrointestinal bleeding, and in one — multi-organ failure. Among dead patients there were 28 (90.3%) with CHD, all of them having complicated aneurysms.

Conclusion. The leading cause of fatal cases in operations for abdominal aortic aneurysms is acute cardiovascular insufficiency due to major bleeding, as well as fatal coronary event. The use of a staged surgical approach enables to improve the results of surgical management of patients with abdominal aortic aneurysm combined with CHD.

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Katynov V.V., Loginov О.Е., Kordatov P.N., Maksimov А.L., Ryazanov М.V., Chebotar Е.V., Ivanov L.N. The Optimization of Surgical Management of Abdominal Aortic Aneurysms Combined with Coronary Heart Disease. Sovremennye tehnologii v medicine 2013; 5(3): 63