The surgical treatment of patients with abdominal aorta aneurysm combined with carotid artery stenosis

Abstract

The aim — to improve the treatment results of patients with a bdominal aorta aneurysm (AAA) by reducing their neurological complications risk.Materials and methods. During 2001 — 2018 an ultrasound duplex scan of carotid arteries was performed for 847 patients with AAA. In 84 (9.9 %) patients, concomitant stenosis of the internal carotid artery > 75 % was found. The average age of the patients was 61.3 ± 2.7 years. Men prevailed among the patients (78 (92.9 %)). All patients underwent a comprehensive examination. One‑stage carotid endarterectomy and open resection of AAA were performed in 25 (29.8 %) patients, staged carotid endarterectomy with the second stage of AAA repair — in 24 (28.6 %), staged AAA resection with the second stage of carotid arteries revascularization — in 16 (19.1 %) patients. Two‑stages intervention was performed in 7 (8.3 %) patients with a combination of an internal carotid artery stenosis, AAA and peripheral artery disease , the first stage was intervention on the carotid arteries, on the second stage (from 3 to 7 days) the reconstruction of the abdominal aorta and arteries of the lower extremities were done. In 7 (8.3 %) patients with concomitant coronary artery disease the two‑stages intervention was performed, with the primary one‑stage revascularization of the carotid and coronary arteries, and in 5 (6.0 %) — three‑staged reconstruction in the following sequence: carotid endarterectomy, coronary artery bypass grafting, reconstruction of the abdominal aorta.Results and discussion. No case of cerebrovascular accident in patients undergoing primary revascularization of the carotid arteries, either simultaneous, or staged was noted. In a group of patients who underwent an intervention on the abdominal aorta without carotid and coronary pathology correction, 1 patient developed ischemic stroke with a fatal outcome. Another 1 patient had myocardial infarction in the first postoperative day. The overall level of neurological complications was 1.2 %. The duration of hospitalization was 11.7 ± 0.7 days for patients with simultaneous interventions and 19.5 ± 0.6 days for staged treatment, stay duration in the intensive care unit were 2.1 ± 0.3 and 4.3 ± 0.5 days respectively.Conclusions. During planning of interventions on AAA the screening test of even clinically non‑manifested arterial segments (carotid and coronary arteries, arteries of the lower extremities) is necessary according to multi‑vascular nature of atherosclerotic lesions. The primary revascularization of the carotid arteries (symptomatic stenoses over 75 %, asymptomatic stenoses with high embolic risk) has to be done prior to the reconstruction of the AAA. The method of one‑stage operation on carotid arteries and abdominal aorta with a weighted risk assessment and plan of aortic intervention is more appropriate.