Гендерные особенности морфологических изменений стенки брюшной аорты у больных с аневризматическим и окклюзионно-стенотическим поражением аорто-подвздошного сегмента

Relevance. Evidence exists that infrarenal aortic aneurisms and aortoiliac occlusive disease in women are different than in men in terms of anatomical features and more severe clinical course. Gender differences in histopathology of abdominal aorta are not fully studied.The objective was to study gender based differences in histopathology of abdominal aorta in patients with aortic aneurisms and aortoiliac occlusive disease.Methods and materials. The study included 96 biopsy specimens from 71 patients with aorto-iliac lesions (23 women and 48 men). A number of morphological characteristics and expression of matrix metalloproteinase 9 (MMP-9) were analyzed. The data obtained were processed statistically.Results. Adventitial infiltrate and medial sclerosis are more intense in the aneurysm than in occlusive-stenotic lesions, differences in the grade of fibrosis were proven only in men. Regardless of the patients’ gender, adventitial infiltration is denser in the aneurysmal body than in the neck; other changes in the anatomic parts of the aneurysm are similar. MMP-9 expression in the adventitia in the aneurysmal neck is higher in women, than in men. MMP-9 expression in the media and adventitia is higher in men with aneurysm, then with occlusive or stenotic lesion. Almost all indices of the aortic wall remodeling and MMP-9 expression correlate with each other in men with the aneurysm, in contrast to women.Conclusion. Gender based features in histopathology of abdominal aorta and the degree of their correlation may determine differences in the anatomy and course of abdominal aortic aneurysm and aortoiliac occlusive disease in women and men. Введение. У женщин описываются анатомические особенности аневризмы инфраренального сегмента аорты, отмечается более тяжелое течение аневризматического и окклюзионно-стенотического поражения аорто-подвздошного сегмента. Гендерные особенности морфологических изменений стенки аорты изучены недостаточно.Цель – изучить гендерные особенности структурных изменений стенки брюшной аорты у больных с аневризмой и окклюзионно-стенотическим поражением аорто-подвздошного сегмента.Методы и материалы. Изучены 96 биоптатов стенки брюшной аорты 71 пациента с поражением аорто-подвздошного сегмента (23 женщины, 48 мужчин). Анализировали ряд морфологических характеристик и экспрессию матриксной металлопротеиназы 9 (MMP-9). Полученные данные обрабатывали статистически.Результаты. Клеточный инфильтрат в адвентиции и склероз в медии более выражены при аневризматическом, чем при окклюзионно-стенотическом поражении, различия в степени фиброза зарегистрированы только у мужчин. Вне зависимости от пола пациентов клеточная инфильтрация в адвентиции более выражена в области аневризматического мешка, чем в области шейки аневризмы, другие изменения стенки аорты в зоне шейки и тела аневризмы носят однотипный характер. В шейке аневризмы экспрессия ММР-9 в адвентиции у женщин выше, чем у мужчин. Экспрессия MMP-9 в медии и адвентиции у мужчин выше при аневризматическом, чем при окклюзионно-стенотическом поражении. У мужчин с аневризмой, в отличие от женщин, практически все показатели глубины перестройки стенки аорты и экспрессии ММР-9 коррелируют друг с другом.Заключение. Гендерные особенности морфологических изменений стенки аорты и степени их сопряженности могут обусловливать различия в анатомии и течении аневризматического и окклюзионно-стенотического поражения аорто-подвздошного сегмента у больных разного пола.

К вопросу о критическом артериальном стенозе

Cardiovascular disease (CVD) is the leading cause of death worldwide. The main contribution to the structure of mortality from CVD is made by atherosclerosis. Indications for surgical treatment of patients with diseases caused by atherosclerotic lesions of the arteries are set taking into account the degree of their stenosis. Angiography has been considered the gold standard for screening patients with CVD for many years. Numerous studies carried out over the past several decades have revealed the weak side of this method in assessing the significance of borderline stenosis. Therefore, to analyze such changes, functional tests were introduced to clarify the indications for surgical intervention. Currently, criteria for the significance of stenosis of the iliac, renal and coronary arteries have been determined. The significance of stenosis of the arteries supplying the brain and intestines is still a matter of debate and requires further study.Сердечно-сосудистые заболевания (ССЗ) занимают 1-е место среди причин смерти во всем мире. Основной вклад в структуру смертности от ССЗ вносит атеросклероз. Показания к хирургическому лечению пациентов с заболеваниями, вызванными атеросклеротическим сужением артерий, выставляются с учетом степени их стеноза. На протяжении многих лет «золотым стандартом» обследования пациентов с ССЗ считается ангиография. Множественные исследования, проведенные за последние несколько десятков лет, выявили слабую сторону этого метода в оценке значимости пограничных стенозов. Поэтому для анализа таких изменений были введены функциональные тесты, уточняющие показания к хирургическому вмешательству. В настоящее время определены критерии значимости сужения подвздошных, почечных и коронарных артерий. Значимость стенозов артерий, кровоснабжающих головной мозг и кишечник, до сих пор остается предметом дискуссий и требует дальнейшего изучения

Gender features of etiopathogenesis, clinical and anatomical picture, tactics and results of surgical treatment of infrarenal aortic aneurysm in women

The review includes the analysis of the literature data on the features of etiopathogenesis, clinic, tactics and results of treatment of infrarenal aortic aneurysm

SURGICAL STRATEGY IN PATIENTS WITH ABDOMINAL AORTIC ANEURYSM AND COINCIDENTAL MALIGNANCY OF DIFFERENT LOCALIZATION

Abdominal aortic aneurysm was detected in 269 patients and 26 (9,6 %) of them had a coincidental malignancy. There were 25 (96,2 %) men and 1(3,8 %) woman of age from 46 to 88 years (on the average 67,9±1,7 years old). All of them had different accompanying diseases, influencing the choice of treatment strategy. More than half of patients (16 (61,5 %) had the advanced stage III or IV (3H) of cancer and three of them occupied the first place due to their wide occurrence: tumors of lung — 42,3 %, of stomach — 19,2 %, of large intestine — 11,5 %. The operations were performed in 8 patients with malignancy and in 2 patients with abdominal aortic aneurysm. Two-step operations were performed in 4 patients, the simultant operation — in one patient

RISK STRATIFICATION IN SELECTIVE SURGERY OF ABDOMINAL AORTIC ANEURYSM

A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93,0%) and 177 (94,1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65,4% patients and kidney disease — in 48,9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20 (10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM ). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system

PREDICTIVE RISK ASSESSMENT SCALE OF ISCHEMIC COLITIS DEVELOPMENT IN PATIENTS WITH ELECTIVE INFRARENAL AORTIC ANEURISM REPAIR

The article presents the scale developed by authors of prognostic assessment of ischemic colitis evolution in patients after planned resection of infrarenal aortic aneurism. A retrospective analysis of medical histories of 201 operated patients and statistical data manipulation were made at the period from 1985 to 2016. It was stated, that score less than 2 points represents patients of high risk group of ischemic colitis development. The scale of sensitivity consisted of 80% and scale of specificity - 63,4%. The score of developed scale depended of passability and blood flow condition in the inferior mesenteric, the right and left internal iliac arteries being evaluated during surgery. The aim of surgeons is to increase the number of points in the scale using revascularization of the inferior mesenteric and at least one of internal iliac artery in patients of the high risk group of ischemic colitis development

RESPIRATORY AND RENAL INSUFFICIENCY AS RISK FACTORS OF SURGICAL TREATMENT OF PATIENTS WITH AORTIC ANEURYSM OF THE INFRARENAL SEGMENT

Retrospective analysis of data in 188 patients showed, that chronic nonspecific pulmonary disease was diagnosed in 65,4 % of all. Disorders of bronchial patency of different degrees of manifestation were noted in 61,2 % and 19,7 % of patients had a hypoxemia. Renal diseases were found in 59 % of patients, resulting in the development of chronic renal insufficiency in 17 %. The data obtained indicate, that the presence of coexisting pulmonary pathology directly influences the frequency and severity of respiratory complications after surgery, which can be the cause of fatal outcome. The presence of renal diseases results in three times higher risk of the development of postoperative renal complications

LONG-TERM RESULTS OF RECONSTRUCTION OF THE INFERIOR MESENTERIC AND INTERNAL ILIAC ARTERIES DURING RESECTION OF THE ANEURYSM OF THE INFRARENAL AORTIC SEGMENT

The  OBJECTIVE   is  to  assess the  patency  of  the  inferior  mesenteric artery   and   internal   iliac  arteries in  the  remote period  after  resection of the  aneurysm of the  infrarenal  aortic  segment. MATERIAL AND METHODS.  The  study  included 33  patients who  underwent resection  of  the  abdominal aortic  aneurysm with  reconstruction of  the  inferior  mesenteric artery  and  (or)  internal  iliac  arteries from  1998  to  2017.   All patients were  examined with  computed  tomography scan with  contrast to  assess the  patency of  inferior  mesenteric artery  and   internal  iliac  arteries. RESULTS.   Patients  were observed from  0.5  to  15  years. Among  30  patients with  inferior  mesenteric artery   implanted  into  the  prosthesis,  23 (76  %)  patients had  a  passable inferior  mesenteric artery  and  7  patients had  an  occluded inferior  mesenteric artery. The  implanted  inferior  mesenteric artery   maintained its  patency for  3  years in  100%   of  cases, from  3  to  5  years  – in  86%,  after  5  years and   more   –  in  62%.  In  one   patient   who  underwent  reconstruction  of  the  internal   iliac  artery, thrombosis  of  the  prosthetic-internal  iliac  shunt   was   found  out  in  1.5  years  after  the  operation,  without  any  clinical manifestations. One  patient,  underwent the  reconstruction of the  internal  iliac artery,  was  diagnosed with thrombosis of the prosthetic-internal iliac  shunt   in  1.5  years after  the  operation, which  was   not  accompanied by  clinical  manifestations. CONCLUSION.  The  high  remote patency of the  inferior mesenteric artery  and  internal  iliac arteries reconstructed during resection of the aneurysm of the infrarenal aortic segment indicates the need for this procedure in order to prevent ischemic disorders of the digestive organs and pelvis

ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENTION AS RISK FACTORS OF SURGICAL TREATMENT OF PATIENTS WITH INFRARENAL SEGMENT OF AORTIC ANEURYSM

A retrospective analysis of the data of 188 patients with the infrarenal segment of the aortic aneurysm (ISAA) showed, that ischemic heart disease and arterial hypertension were diagnosed practically in all patients — 175 (93.0%) and 177 (94.1%) patients respectively. A decreased retractor function of the myocardium was noted in 88 (46.8%) of patients. According to the findings of echocardiography 134 (71.3%) patients had the arterial hypertension of third degree. For the assessment of the influence of the accompanying cardiac pathology on the results of planned surgical treatment and systematization of postoperative cardiac complications the classification, which was proposed by R. B. Rutherford et al. and modified by A. V. Pokrovsky et al. was used. The obtained data point at a direct proportional relationship between the degree of the initial cardiac status, frequency and severity of postoperative cardiac complications in patients after resection of ISAA in 1.6–2.3 times

METHODS FOR PRESERVATION THE PATENCY OF THE INTERNAL ILIAC ARTERIES DURING INFRARENAL AORTIC ANEURISM RESECTION

OBJECTIVE. The purpose of this study was to evaluate the methods for preservation the patency of the internal iliac arteries during infrarenal aortic aneurysm resection.MATERIAL AND METHODS. The retrospective review was conducted in 200 patients who had undergone infrarenal aortic aneurysms resection between 1998 and 2017. The group 1 consisted of 8 patients who underwent the antegrade internal iliac arteries flow restoration by bypass or prosthetics. The group 2 consisted of 25 people who did not undergo restorating the patency of these arteries. The results were compared in both groups during the intraand early postoperative period.RESULTS. During the statistical analysis, there were no significant differences in duration of operation postoperative period, blood loss between two groups. Among the patients of the group 2, a transient ischemic colitis developed in one case, a prosthesis thrombosis developed in 5 patients. The complications described above have never been noted in the group 1.CONCLUSION. Direct revascularization of the internal iliac arteries during infrarenal aortic aneurism resection is an important factor of preventing the ischemic disorders of the pelvic organs and the left half of the colon do not significantly affect the volume of blood loss and the duration of the operation and the postoperative period