Open surgery for abdominal aortic aneurysms at the present stage

• Vachev A.N.
• Chernovalov D.A.
• Dmitriev O.V.
• Italiantsev A.Yu.
• Kozin I.I.
• Gryaznova D.A.
• Kutsenko V.V.
• Andreeva Yu.V.
• Akhmedkhanova S.N.

Abstract

Background. Currently, open operation of aortic prosthetic repair for abdominal aortic aneurysms remains one of the main methods of treatment, making it possible to achieve sustainable. However, the approaches to obligatorily performing separate stages of the perioperative management and separate stages of the operation itself seem far from being standardized.

Objective. The purpose of this study was to work out a specific, obligatory-to-perform technology of open prosthetic repair for an abdominal aortic aneurysm, to be associated with both a minimal rate of intraoperative complications and long-term favorable postoperative outcomes.

Patients and methods. Our single-center retrospective and prospective cohort study included a total of 284 elective patients presenting with an abdominal aortic aneurysm and subjected to open prosthetic repair. Depending on the technology of managing the perioperative period and the technical aspects of surgery, the patients were divided into two groups. Group 1 (retrospective) comprised 89 patients with abdominal aortic aneurysms treated by elective AAA repair according to the generally accepted intrasaccular method known as endoaneurysmorrhaphy. There was no unified strategy of the perioperative management and performing separate stages of the operation in patients of this group. Group 2 (prospective) was composed of 195 patients with abdominal aortic aneurysms, who underwent elective prosthetic repair according to the worked-out technique with aneurysmal sac reduction. The perioperative management and compulsory-to-perform separate stages of the operation were standardized.

Results. Statistically significant differences were obtained for the frequency of cardiac (p<0.001) and respiratory complications (p=0.009), as well as acute renal damage (p=0.007). Also, a statistically significant difference was observed between the two groups in the volume of intraoperative blood loss (p<0.001). The remote results were followed-up for 14 years. The frequency of reoperations amounted to 2.7%, accounting for either stent-branch thrombosis or the development of an aneurysm of the distal graft-femoral anastomosis. No aneurysms of the proximal anastomosis were revealed.

The operation of open repair for abdominal aortic aneurysms remains one of the main methods of treatment. Strictly complying with the clear-cut technology of the intraoperative management and performing the stages of the operation itself made it possible to statistically significantly decrease the volume of intraoperative blood loss, the amount of required transfusion of blood substitutes, postoperative complications, and to increase freedom from reoperation in the remote period.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Vachev A.N.; data collection and handling – Vachev A.N., Chernovalov D.A., Dmitriev O.V., Italiyantsev A.Yu., Kozin I.I., Gryaznova D.A., Kutsenko V.V., Andreeva Yu.V., Akhmedkhanova S.N.; statistical processing – Chernovalov D.A., Kozin I.I.; draft manuscript preparation – Chernovalov D.A., Kozin I.I.; manuscript revision – Vachev A.N.

For citation: Vachev A.N., Chernovalov D.A., Dmitriev O.V., Italiyantsev A.Yu., Kozin I.I., Gryaznova D.A., Kutsenko V.V., Andreeva Yu.V., Akhmedkhanova S.N. Open surgery for abdominal aortic aneurysms at the present stage. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (1): 41–52. DOI: https://doi.org/10.33029/1027-6661-2024-30-1-41-52

Keywords:abdominal aortic aneurysm; aortic prosthetic reconstruction; endoprosthetic aortic repair; aneurysmal sac reduction; open aortic surgery