Lyah S. Prognostication of flow of symptomatic aneurysms of abdominal aorta at their surgical treatment

The thesis sets out the theoretical rationale and new issues of diagnosis and treatment of patients with symptomatic aneurysms of the abdominal aorta through the implementation of the proposed technology aimed at reducing the number of complications and fatality rates. The thesis a systematic study of diagnostic data, identified the clinical features of the most common complications of symptomatic aneurysms of the abdominal aorta, justified the leading role ultrasound USDS and CT in the diagnosis of location, size and the amount of aneurysms and proposed a number of options etiopathogenetic priority diagnosis and surgical treatment of patients with symptomatic aneurysms of the abdominal aorta. For the first time on a large clinical material proved the possibility of surgical treatment using minimal access aneurysms of the abdominal aorta and developed methods of temporary hemostasis of the abdominal aorta and a selection of indications for surgical treatment of diseases of the abdominal aorta. On the basis of the method developed in the early diagnosis of clinical predictor of aneurysm rupture to the forecast the results of the analysis of the level of interdependence fraction of matrix metalloproteinase-9 in plasma and risk factors for symptomatic outcomes - symptomatic , diameter and growth rate. According to the study evaluated the ability to project a predictor of aneurysm rupture and developed an algorithm for deciding on treatment (surgical or conservative) tactics in patients with symptomatic aneurysms. It is proved that symptomatic aneurysms resection is often associated with the occurrence of severe complications , including ischemic kolitis. S prevail to prevent the development of ischemic complications associated with extensive resection of symptomatic aneurysms, unsubstantiated diagnostic and prognostic significance of objective research methods - direct electromanometry and duplex ultrasonography of internal iliac and inferior mesenteric artery in the evaluation of the adequacy of the blood supply of the left half of the colon and rectum. It is proved that the morphofunctional and ultrastructural changes in the tissue of the vascular wall in places anastomoses at dissecting symptomatic aneurysms, reduce the possibility of reparative endothelial cells and influence the disturbance of laminar blood flow. Analysis of the results of the study and the comparative results of different methods of treatment could identify groups of patients for the traditional treatment, "open" surgery and possibilities of use in clinical practice minimally invasive technologies. For timely diagnosis offered in practical health care available clinical and laboratory techniques as well as a number of classification criteria for symptomatic aneurysms