Nykonenko A. Diagnostic and treatment of abdominal aortic aneurism and diseases of visceral branch

The dissertation is devoted to the actual problem of vascular surgery - diagnosis and treatment of abdominal aortic aneurysm disease and its branches based on the clinic of disease, modern diagnostic techniques and morphological changes in tissues and application of minimally invasive surgical techniques. The paper presents the data of 402 patients. Among which abdominal aortic aneurysm have 278, 94 patients with occlusive-stenotic disease of unpaired visceral branches of the aorta and 30 with aneurysms of unpaired visceral branches. There were carried out modern survey methods - CT, U.S. Proposed and developed study protocols and special functional tests. The technique of estimating the volume of the aneurysm by CT and calculation of the risk of rupture on the developed formula were developed. In the formula takes into account the ratio of the thrombus cavity volume to the volume of the aneurysm. The dissertation proposed a method for describing data in the case of abdominal aortic aneurysm, reaffirmed the central role of CT (more than 64 slices) in the diagnosis of abdominal aortic aneurysm. The main advantage of this method is a full range of information about the presence of occlusive-stenotic process in the visceral branches, what is important for the decision of treatment. The changes in blood tests TNF-? and interleukin-6 indicate the presence of inflammation and homocysteine levels, which indicates a high degree of atherosclerotic activity, as well as vitamin D3 - revealed the state of hypovitaminosis. Revealed changes at abdominal aortic aneurysm say about a specific process of the aneurysm and the presence of concomitant pathology. Based on the analysis of the results it was proposed and developed a method for comprehensive diagnosis of patients with abdominal aortic aneurysm. The required survey methods include U.S. and coronary angiography for detection of significant stenosis of coronary and carotid arteries. In order to reduce mortality and complications the correction of significant stenosis was performed before resection of abdominal aortic aneurysm. Surgical treatment of abdominal aortic aneurysm was performed using minimally invasive techniques - abdominal aortic aneurysm resection of minimal access, the application of seamlessly ring anastomosis and endovascular stent graft. The use of CT has made it possible to obtain valuable information about the state of visceral branches to reduce the risk of abdominal ischemia in the postoperative period. Applied methods of surgical treatment show a significant benefit (p<0.05) over standard therapies. The dissertation shows the group of patients whom for certain indications the conservative therapy was performed. The principle of treatment was worked out on the basis of modern data pathogenesis. Growth control after treatment was done by U.S. or CT. Drug therapy will help to stabilize the growth of the aneurysm (p<0.05). Morphological study revealed a significant degree of inflammatory reaction in the wall of the aneurysm. Cyclophilin-A detected in the wall of the aneurysm in greater amount than in atherosclerosis and is one of the key moments of abdominal aortic aneurysm formation. Occlusive-stenotic lesion caused by visceral branch 68.5% cases extravasal compression and 31.5% in atherosclerosis. Application of diagnostic techniques has allowed to establish the maximum amount of compression and differentiate genesis compression. Application of intraoperative U.S. research improves the quality of surgery. It is shown that the stent is effective only when it has atherosclerotic genesis. Morphologically identified ischemic and inflammatory changes in the tissues of the abdominal cavity. In this paper, processed information about aneurysms visceral branch. Established that there is no characteristic clinic of disease and clinical manifestations are due to co-morbidities . The optimal method of diagnosis is CT. According to the analysis of surgical treatment tactics of treatment - endovascular treatment is preferable.