CC BY
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III. SURGERY
CLINICAL AND ACADEMIC ASPECTS OF PERIPHERAL ARTERY ANEURISM. REVIEW. PART TWO
Khanchi M., Matkerimov A.Zh, Demeuov T.N., Baubekov A.A., Zhakubayev M.A., Tergeussizov A.S., Tajibayev T.K., Shamshiev A.S., Yerkinbaev N.N., Makkamov R.O., Saduakas A.Y.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan
Abstract
The problem of choosing tactics for treating patients with peripheral artery aneurysm of various etiology and localization. Probably, it will be relevant for vascular surgeons who periodically face non-trivial clinical situations requiring non-standard solutions. Surgical intervention on aneurysmically dilated vessels should be carried out using preoperative diagnostic training, including instrumental examination, in order to determine the volume of intervention, access, and stratification of operational risk.
МРНТИ 76.29.35
Khanchi M. —
orcid.org/0000-0002-9372-4707
Matkerimov A.Zhv —
orcid.org/0000-0001-8492-2958
Baubekov A.A —
orcid.org/0000-0001-7197-4871
Tergeussizov A.C. —
orcid.org/0000-0002-5069-4034
ZhakubayevM.A. —
orcid.org/0000-0002-0376-3172
Tajibayev T.K. —
orcid.org/0000-0002-9007-063X
Makkamov R.O. —
orcid.org/0000-0002-7222-1713
Yerkinbaev N.N. —
orcid.org/0000-0003-1409-6624
Saduakas A.Y. —
orcid.org/0000-0001-
Shamshiev A.S. —
orcid.org/0000-0001-
9213-2630 5868-057X
Keywords
complex surgical treatment of peripheral artery aneurysms
Перифериялык артерия аневризмасыньщ клиникалык жэне академиялык аспектшерк Эдебиетке шолу. 2 бeлiм
Ханчи М., MaTKepiMOB А.Ж., Демеуов Т.Н., Баубеков Э.Э., Жакубаев М.А., Тергеуазов А.С., Тэжiбаев Т.К., Шамшиев А.С., Ерюнбаев Н.Н., Маккамов Р.О., Садуакас А.С.
«А.Н. Сыз?анов атында?ы Улттык, ?ылыми хирургия орталь™» АК,, Алматы, Казахстан
Ацдатпа
ТYрлi этиологиядаты жэне локализациядаты перифериялык, артериялардыц аневизмасы бар наукастарды ем-деу тактикасын тацдау мэселеа стандарттан тыс шешiмдердi кажет ететн бейтривиал клиникалык жатдаяттармен туракты тYPде ушырасатын тамыр хирургтары Yшiн езет болуы MYMm. Аневризмалык кецейген тамырлар€а хирургиялык араласуды жYргiзу операциялык кауш стратификациялау, колжетiмдiлiктi жYзеге асыру, араласу келемн аныктау максатында аспаптык зерттеудi камтитын операция алдындаты диагностикалык дайындыкты пай-далану аркылы етуi тшс.
Туйш сездер
перифериялык артериялар аневризмасын кешендi
хирургиялык емдеу
Клинико-академические аспекты аневризм периферических артерий. Обзор литературы. Часть 2
Ханчи М., Маткеримов А.Ж., Демеуов Т.Н., Баубеков А.А., Жакубаев М.А., Тергеусизов А.С., Таджибаев Т.К., Шамшиев А.С., Еркинбаев Н.Н., Маккамов Р.О., Садуакас А.С.
АО «Национальный научный центр хирургии им. А.Н. Сызганова», Алматы, Казахстан Аннотация
Проблема выбора тактики лечении пациентов аневризма периферических артерии различных этиология и локализация. Вероятно, будет актуальной для сосудистых хирургов, периодически сталкиваются с нетривиальными клиническими ситуациями, требующими нестандартного решения. Проведение хирургического вмешательства на аневризматически расширенных сосудах должно проводиться с использованием предоперационной диагностической подготовки, включающей инструментальное обследование, с целью определения объема вмешательства, осуществления доступа, стратификации операционного риска.
Ключевые слова
комплексное хирургическое лечение аневризм периферических артерии
1.3. Surgical techniques for the treatment of peripheral arterial aneurysms
A radical method, when performing operations on the peripheral arteries of the lower extremities, are used open options of intervention [Belyakin SA, Pinchuk OV, Obraztsov AV, et al., 2014; Bracale U. M., Corte G., Di Gregorio A. et al., 2011]. However, endovascular surgical techniques have become very popular both among surgeons and patients, since modern stent designs have begun to be used in the prosthetics of those vessels that undergo constant flexion-extensor deformation under physiological conditions [Antoniou G.A, Schiro A., Smyth J.V. et al., 2012].
Summarizing the analytical information obtained in the study of literature data provided by domestic and foreign researchers, the following types of surgical interventions performed for aneurysms in the PSS can be distinguished [Belyakin S.A., Pinchuk O.V., Obraztsov A.V. ., 2014]:
1. Resection of the aneurysm followed by repeated arterial reconstruction;
2. X-ray endovascular stenting with a stent-graft (percutaneous or open access);
3. Resection of aneurysm with artery replacement;
4. Ligation of the adductor and outflow arteries with bypass grafting;
5. Resection of the aneurysm with suture (plastic in the damaged area) of the artery;
6. Amputation of a limb (primary or after ligation of arteries);
7. Excision of the aneurysm without revascularization
8. Ligation of arteries
Some works contain descriptive cases of surgical tactics used for aneurysms of the vessels of the upper limb. According to the authors, there are only literary indications of the likelihood of such a problem, and the primacy of the clinical description of this type of pathology belongs to them. The team of authors C. Bouvet, S. Bouddabous and J.Y. Beaulieu. operated on four patients with aneurysms of the vessels of the hand: one had an aneurysm of the thumb of the palmar digital artery, another in the area of the superficial palmar arch, and two others in the ulnar artery. All patients underwent excision with direct coronary artery bypass grafting; the patient has no venous prosthesis. All patients were followed up for several years after the operation, they underwent ultrasound to check the patency of the anastomosis, followed by arteriography for acute ischemia or CT angiography or MR angiography if necessary. All anastomoses were patent within 2 to 8 years after surgery. According to the authors' recommendation, it is better to use a straight arterial suture at the proximal and distal
anastomosis for long-term permeability [Bouvet C, Bouddabous S, Beaulieu JY., 2018].
Endovascular interventions, despite a number of advantages over open surgical treatment, are invasive techniques and involve complications such as pulsating hematomas and false aneurysms of peripheral vessels, and their number increases in proportion to the spread of angiographic methods of diagnosis and treatment, . According to the literature, in the structure of local complications after puncture of the artery, false aneurysms occupy 60-80% Andall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016 Jul. To reduce the incidence of complications, transaxillary, transbrachial and transradial approaches and suturing instruments are now more commonly used. However, even with such approaches and the development of endovascular technologies, damage to the punctured artery was noted. Today, surgical and compression methods with various modifications of them are relevant types of treatment for pulsating hematomas and false aneurysms.
Endovascular vascular occlusion is a relatively fast and less traumatic method that can be used either as an independent type of treatment,
In addition, endovascular treatment can be used to treat carotid artery aneurysms, bifurcation aneurysms, which often occur at a younger age. This method of treatment has been proven to be safe and acceptable [Ban SP, Hwang G, Kim CH, et al., 2018; Konczalla J, Platz J, Brawanski N, et al., 2015; Oishi H, Yamamoto M, Nonaka S, et al., 2013].
Thus, surgical intervention on aneurysmically dilated vessels should be carried out using preoperative diagnostic preparation, including instrumental examination, in order to determine the scope of intervention, access, and stratification of operational risk.
1.4. Complications of aneurysms and possible postoperative complications
Continuous postoperative observation is recommended after all types of interventions for aneurysms. Although its purpose is to prevent and / or detect early complications. With endoscopic interventions, the early postoperative period proceeds more safely [Baderkhan H, Haller O, Wanhainen A, et al., 2018].
Among all postoperative complications, 6
1. Early:
1.1. Bleeding
1.2. Suppuration
1.3. Lymphorrhea
1.4. Shunt or prosthesis thrombosis.
Somatic complication of the immediate postoperative period with PAA
1.1 Pneumonia
1.2 Exacerbation of chronic bronchitis
1.3 Myocardial infarction
1.4 acute cardiac vascular failure
Complications arising in the zone of access
to the vessels during endovascular interventions occur in 5% - 16% of cases [Knowles M, Nation DA, Timaran DE, et al., 2015].
It is known that the stent configuration itself does not lead to postoperative complications [Schuurmann RCL, van Noort K, Overeem SP, et al., 2018].
Thus, when carrying out surgical treatment of patients with aortic and PAA aneurysms, it is necessary to take into account possible complications for stratification of postoperative and intraoperative risk.
Literary analysis we can be noted that the increase in the spread of peripheral aneurysms of various etiology.
Surgical peripheral aneurysm
There are no disagreements about the pathological anatomy and pathogenesis, until now there is no clear algorithm for diagnosing patients with APA. On the one hand, this leads to late diagnosis of the disease, after the development of its complications. The need for timely diagnosis of peripheral aneurysms is beyond doubt. However, focusing on literary sources, it can be noted that the problem is still far from being resolved.
Thus, the problems associated with the diagnosis and surgical treatment of PAA cannot be considered finally solved, since many issues need further research and development.
1.5. Organization of preventive medical care for patients with aneurysms of the vascular wall
Preventive and preventive medical care for patients with aortic aneurysms who are subject to surgical treatment is based on the timely detection and prevention of complications and / or adverse consequences after surgery.
References
1. S.A. Belyakin, O.V. Pinchuk, A.V. Samplesov, V.V. Ya-menskov, 1- 3rd diagnostics and treatment of peripheral arterial aneurysm of lower extremities, Central Military Clinical Hospital named after V.V. Lomono-sov. A.A. Vishnevsky Central Military Clinical Hospital, Moscow, Russia. Krasnogorsk, Moscow region Number: 7 Year: 2014 Pages: 24-27,
2. A.K. Baratov1, O.N. Sadriev1, E.L. Kalmykov2,
One of the serious dangerous consequences of aneurysms is their rupture. Russian scientists have developed a special risk assessment scale for dissecting aortic aneurysm. This scale allows, at the pre-hospital stage of patient care, to identify those clinical factors and symptoms that can lead to this disease [Semenova L.N., Morova N.A., Potapov V.I., et al., 2016].
Until now, there is no clear algorithm for diagnosing patients with APA, on the one hand, this leads to late diagnosis of the disease, after the development of its complications. On the other hand, the development of modern diagnostic methods has not yet led to a generally recognized revision of recommendations for diagnostic tactics. The most controversial issue is the mandatory use of angiography in the diagnosis of this condition.
The need for timely diagnosis of APA does not raise doubts. However, focusing on literary sources, it can be noted that the stage of the problem is still far from being resolved. Also, many studies note that the surgical treatment of this pathology cannot be considered definitively developed. are primarily associated with the variety and complexity of anatomical options, a feature of hemodynamic disorders. The availability of various and far from diverse methods of surgical treatment.
Thus, the clinical diagnosis of aneurysms and peripheral arteries (APA) is based on the histogenetic, pathomorphological and pathophysiological features of the structure and functioning of the vascular wall. Consequently, a detailed and updated understanding of the morphological principles of the structure of blood vessels, the role and participation of the tissues forming the vascular wall is needed, which allows using high-tech diagnostic equipment to verify its pathological changes at early stages. Although improved imaging techniques such as X-ray, ultrasound, and echocardiogram have contributed to the earlier detection of aneurysms, surgery is currently the only treatment available. Undoubtedly, the volume of medical intervention, conservative or surgical, is determined taking into account the nuances listed above, which are presented in more detail in this section of the work.
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