Relevance. Cardiovascular disease (CVD) is the leading cause of death
worldwide, killing more people each year than any other cause. In 2015, an
estimated 17.7 million people died from CVD, accounting for 31% of all deaths
worldwide. More than 75% of CVD deaths occur in low- and middle-income
countries.
Atherosclerosis of the abdominal part of the aorta and its paired branches is
a frequent and complex pathology in diagnosis and treatment. Damage of only one
vascular basin is infrequent. This pathological process is characterized by a
multifocal form of damage involving two or more vascular bays. The
atherosclerotic process in the aorta walls occurs earlier and more frequently than in
other arterial vessels. However, clinical aortic atherosclerosis usually first appears
in the fifth or sixth decade of life, with even more complex forms of the disease
lasting asymptomatically. Atherosclerotic conditions of the paired branches of the
abdominal aorta may be combined with abdominal aortic aneurysm or stenoticocclusive lesions of the aorta itself. In the structure of cardiovascular disease, they
are at the top of the list. The timely diagnosis and treatment of these diseases
remains an urgent problem, as the mortality rate for complications ranges from
60% to 80% [116].
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In recent years, it has been proven that the peculiarities of the anatomical
and histological structure of the abdominal aorta contribute to the characteristic
course of the disease of this organ. Due to that, it is highly relevant to study the
peculiarities of the structure of the wall of the abdominal aorta and changes in its
morphology during the formation and progression of the atherosclerotic process. A
detailed study of this process is of great scientific and practical importance since it
depends on the treatment method, the possibility of prescribing conservative
therapy affecting the inflammatory process in the vessel wall or performing
surgical intervention on the affected segment by stenting or bypass [63].
Atherosclerosis of renal arteries is polymorphic in terms of clinical
symptoms. Recently, renal artery stenoses have been the cause of resistant
hypertension. Ultrasound examination is a screening method for diagnosing renal
artery stenosis. What is more, thousands of patients suffer from renal failure,
which mainly occurs in patients with diabetes. Still, in many cases, it is associated
with atherosclerotic lesions of the renal arteries and the development of ischemic
nephropathy. There are many controversies concerning assessing and treating
stenotic-occlusive conditions of the renal arteries and their relationship to
hypertension and renal failure. Most reconstructive surgery for this problem today
is done with interventional techniques [32].
Interest in the renal arteries in abdominal aortic aneurysms and occlusivestenotic lesions of the aorta and its bifurcation always arises because the
proportion of renal complications in compromised kidneys occurs today. In this
regard, it is essential to develop a comprehensive diagnostic program to assess the
degree of circulatory disorders and the risk of developing possible complications
[44].
The development of methods of diagnosis surgical and anaesthetic support
leads to a decrease in operative complications and mortality. However, the
development of neurological complications remains a severe problem, the solution
of which has not been found to this day. Spinal cord infarcts are pretty rare but, at
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the same time, severe in their consequences, which significantly affect the quality
of life [31]. There have been numerous reports of cases of spinal ischemia
following planned prosthetic surgery due to an abdominal aortic aneurysm or
occlusive lesions of the aortoiliac segment resulting in paraplegia, sphincter
failure, and dissociated loss of sensation. According to the world literature, spinal
ischemia with endovascular surgical treatment is 0.21% [7], and with open
reconstructions, complications are 0.5-1% [61]. The mechanism of development of
this complication is multifactorial and now requires more attention in perioperative
management. The result of timely diagnosis and treatment of early spinal ischemia
and the development of surgical tactics for their prevention are relevant. Given the
possibility of occurrence and severity of postoperative complications from the
kidney and spinal cord, a thorough study of this complication is a platform for
improving methods of predicting the occurrence, prevention, diagnosis, and
treatment of the category of patients at risk of the difficulties mentioned above.
Given the above, our study aimed to improve the treatment results of
patients with atherosclerosis of the abdominal part of the aorta and its paired
branches by improving the surgical technique and the methods of predicting and
preventing postoperative complications.
