Results of Surgical Treatment of Patients with Symptomatic Abdominal Aortic Aneurysms

Relevance Abdominal aortic aneurysm is a common disease, manifested by an expansion of the abdominal aorta of more than 3 cm and accompanied by the development of serious complications with high mortality. There are symptomatic aneurysms, asymptomatic aneurysms and ruptured aneurysms. The timing of surgical intervention for symptomatic aneurysms still causes some controversy.

Aim of study To determine the tactics and timing of surgery in patients with symptomatic abdominal aortic aneurysms.

Material and methods The medical histories of 188 patients with symptomatic abdominal aortic aneurysms admitted to the Department of Vascular Surgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 152 men (80.8%) and 36 women (19.2%). The average age of those admitted was 69.8±2.5 years (from 53 to 84 years).

Results All patients were divided into three groups, depending on the time of operation from the moment of admission: those operated in the first 24 hours (n=27); those operated from 24 to 72 hours from the moment of admission (n=20) and those operated later than 72 hours (n=136). The mortality by group was 14.8% in the first group, 20.0% in the second group, 7.3%in the third group.

Conclusions Patients with symptomatic abdominal aortic aneurysm should be admitted to the intensive care unit for evaluation and preparation for delayed surgery. In cases where hospitalization in the intensive care unit is impossible or pain persists, the patient should be operated on urgently. When the pain syndrome is relieved and blood pressure is normalized, the patient can be further examined and operated on in a delayed manner.

1. Natsional’nye rekomendatsii po vedeniyu patsientov s anevrizmami bryushnoy aorty. 2013. (in Russ.) Available at: https://www.angiolsurgery.org/recommendations/2013/recommendations_AAA.pdf?ysclid=l2ri9nffsa [Accessed Jan 23, 2024]

2. Pokrovskiy AV. Zabolevaniya aorty i ee vetvey. Moscow: Meditsina Publ.;1979. (In Russ.)

3. Pasternak J, Nikolic D, Popovic V, Vucaj-Cirilovic V. The importance of timing in surgical treatment of unruptured symptomatic aneurysm of abdominal aorta. Bratisl Lek Listy. 2012;113(11):652–656. PMID: 23137203 https://doi.org/10.4149/bll_2012_147

4. Budinski S, Pasternak J, Manojlovic V, Markovic V, Nikolic D. Significance of delayed surgical treatment of symptomatic non-ruptured abdominal aortic aneurysm. Med Pregl. 2019;72(3-4):80–87. https://doi.org/10.2298/MPNS1904080B

5. Dueck AD, Johnston KW, Alter D, Laupacis A, Kucey DS. Predictors of repair and effect of gender on treatment of ruptured abdominal aortic aneurysm. J Vasc Surg. 2004;39(4):784–787. PMID: 15071441 https://doi.org/10.1016/j.jvs.2003.10.064

6. Pokrovsky AV, Dan VN, Zlatovchen AM, Ilyin SA. Effect of the Cardial Status and Arterial Hypertension on the Results of Surgical Treatment of Patients Over 70 Years with Abdominal Aortic Aneurysms. Angiology and Vascular Surgery. Journal Named after Acad. AV Pokrovsky. 2003;9(1):71–77. PMID: 12811396. (In Russ.)

7. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al.; Society for Vascular Surgery. The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2–49. PMID: 19786250 https://doi.org/10.1016/j.jvs.2009.07.002

8. Vu KN, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux MF, Thérasse E, et al. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging. 2014;5(3):281–293. PMID: 24789068 https://doi.org/10.1007/s13244-014-0327-3

9. Muslimov RSh, Tutova DZ. Imputed Tomography Possibilities in Revealing of Instability Signs of Abdominal Aortic Aneurysms and Predictors of Their Rupture (Literature Review). Diagnostic and Interventional Radiology. 2019;13(3):68–78. https://doi.org/10.25512/DIR.2019.13.3.08

10. Sullivan CA, Rohrer MJ, Cutler BS. Clinical management of the symptomatic but unruptured abdominal aortic aneurysm. J Vasc Surg. 1990;11(6):799–803. PMID: 2359191

11. Tambyraja AL, Raza Z, Stuart WP, Murie JA, Chalmers RT. Does immediate operation for symptomatic non-ruptured abdominal aortic aneurysm compromise outcome? Eur J Vasc Endovasc Surg. 2004;28(5):543–546. PMID: 15465377 https://doi.org/10.1016/j.ejvs.2004.06.017