DETERMINING SURGICAL POLICY IN COMBINED ATHEROSCLEROTIC LESION OF CAROTID ARTERIES IN PATIENTS WITH UNCOMPLICATED AORTIC ANEURYSM

Shcherbyk A.A., Mikhailov A.A., Lemenev V.V., Akhmetov V.V., Koshelev Yu.M., Shamshilin A.A., Kungurtsev E.V., Bondarenko A.N.
Department of Urgent Vascular Surgery Department Research Institute of Emergency Medical Care named after N.V. Sklifosovskii,
Moscow, Russia

Presented herein are the outcomes of managing a total of twenty-six patients suffering from an uncomplicated abdominal aorta aneurysm with a concomitant atherosclerotic lesion of the coronary arteries, referred to our Clinic over the period form 2003 to 2006. Of these, nineteen (70%) patients were diagnosed with the first (symptom-free) stage of cerebral ischaemic disease, and six presented with the second stage [to have endured a transient ischaemic attack (TIA) within the terms from 16 to 3 months prior to admission]. Two patients had residual events of the previously sustained acute cerebral ischaemia (ACI) (stage 4). The current stage of ischaemic cerebral disease was determined according to the classification of A.V. Pokrovskii (1979). The haemodynamically significant stenoses of carotid arteries (over 70%) were revealed in five patients, an aneurysm of the internal carotid artery – in one patient, and eighteen patients were presenting with the degree of carotid arteries stenosis varying from 30 to 60% (of these, in two subjects after previously endured TIA, the plaque was heterogeneous and defined as embolism-threatening). No atherosclerotic lesions of the carotid artery were revealed in two patients, though these patients had previously sustained an AIA with the preserved neurological deficit by the moment of examination. Eight patients underwent reconstruction of the internal carotid arteries. The average age amounted to 64.5 years. All of the eight operated on patients with a combination of ischaemic cerebral disease and an aneurysm of the abdominal aorta were found to have had no neurological complications either after the first, or after the second operations. The devised algorithm of examination and surgical management for patients presenting with an abdominal aorta aneurysm and a combined lesion of the brachiocephalic arteries made it possible to reduce the rate of neurological complication from 4.3% to 1.3%.

KEY WORDS: abdominal aorta aneurysm, carotid artery stenosis, cerebral ischaemic disease.

P. 127-131

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