Sparing Treatment of Thoracic and Abdominal Aortic Aneurysms

Abstract

A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient's life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.

Long-Term Results (Seven and More Years) of Sparing Treatment of Subjects with Descending Aortic Aneurysms

“…It's interesting that aneurysm ruptures were observed practically with similar frequency in those operated and non-operated (33.3% vs. 31%). The same trend had been previously registered when we were analyzing 2-, 4-and 6-year treatment period of such patients [26] [27]. There were no operation deaths in patients with DA although almost half of them (45.5%) had been operated.…”

“…Similarly, in the group with DA, which contained about the same number of operated and non-operated patients, one patient in each group died. The same trends were registered in our previous analyses of 2, 4 and 5 to 6 years of treatment [26] [27]. The EVAR-2 trial has shown that the cumulated number of deaths due to aneurysm ruptures in those treated conservatively was consistent with the number of ruptures and…”