МЕДИКАМЕНТОЗНОЕ ЛЕЧЕНИЕ АНЕВРИЗМЫ БРЮШНОЙ АОРТЫ

Abstract

Abdominal aortic aneurysm (AAA) is a common disease with high mortality. Surgical treatment of AAA is performed routinely at a rate of more than 5 cm. Nowadays there isn’t any drug treatment protocol of small aneurysms. Oxidative stress, chronic inflammation in the wall of the abdominal aorta are the fundamental in the pathogenesis of AAA according to the modern literature. Analysis of the literature and our own experience gives opportunity to develop a comprehensive drug therapy of abdominal aortic aneurysms.Purpose: according to the analysis of the literature and our own research to develop a comprehensive drug therapy of abdominal aortic aneurysms.Methods.This study included 48 patients, who were eamined in the Department of Vascular Surgery in Zaporizhzhya Regional Hospital in the period from 2011 to 2013. The middle age was 69.2 ( 54-87 ) years. In 25 cases there were no complaints on the aneurysm, 18 - defined the formation of a pulsating in abdomen. The rest of the complaints were related to the presence of comorbidity. Apart of standard surveys of blood levels of homocysteine Interleukin-6, TNF has been investigated. The basic instrumental methods include: CT imaging of the aorta, coronary angiography.In this article we analyzed the data of morphological studies of AAA wall, taken at the time of elective making a prosthetic appliance of an AAA. The material was fixed in 10% formalin, embedded in paraffin, sectioned of 4 microns thick. They were stained with hematoxylin - eosin and immunohistochemistry to determine the Cyclophilin A. According to the CT results maximum expansion of the abdominal aorta was 52.27 mm. Coronary angiography was performed in 10 patients, 8 of them had indications for endovascular intervention. Blood tests revealed increasing levels of TNF to 9.83 (7,8-13,9) pg/ml, Interleukin 6 to 5.4 (2-7,46) pg/ml, Homocysteine - 18.39 (11.6 - 29.6) pmol/l.Elective making a prosthetic appliance of an AAA was performed in 6 patients, in 2 cases we performed endovascular aneurysm repair, other patients (n= 40) were appointed medical (conservative, stabilizing) therapy.RESULTS Taking into consideration our morphological study of abdominal aortic aneurysm wall, inflammation and thinning were determined. Intima in many areas was necrotic with attached fragments. Media was thinned, inflammatory changes in the media were in the form of infiltration. Cell infiltrates intensively expressed Cyclophilin A. The main morphological changes in the adventitia were inflammation and fibrosis.Bruemmer D, Collins AR and others have shown in an experimental model following mechanism for the formation of an aneurysm of the abdominal aorta. Angiotensin II through the induction of oxidative stress stimulates smooth muscle cells Cyclophilin A, which triggers the inflammatory cascade, leading to the destruction of the aortic wall.On the basis of our observations (the results of examination of patients), analysis of the literature, we have developed a medical (conservative and stabilizing) therapy, designed to stabilize the growth of small aneurysms, the stabilization of large aneurysms (surgery that cannot be due to certain reasons), the prevention of aneurysmal sac rupture after endovascular surgery. A comprehensive treatment including drugs have a direct effect on the pathogenesis of the aneurysm.