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SHORT- AND LONG-TERM RESULTS OF SURGICAL TREATMENT OF
NONSPECIFIC AORTOARTERITIS
Bakhritdinov F.S.
Suyumov A.S.
Khaybullina Z.R.
State Institution "Republican Specialized Scientific and Practical Medical Center
for Surgery named after academician V. Vakhidov", Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.12217025
Nonspecific aortoarteritis (NAA) is a rare, chronic granulomatous
panarteritis of unknown etiology affecting the aorta and its large branches. The
disease usually occurs at the age of less than 40 years. The pathological process
may involve the aorta, its branches, coronary arteries and pulmonary artery. The
most commonly affected branches are the common carotid and subclavian
arteries.
Material and methods.
A single-center cohort analytical study of patients
with nonspecific aortoarteritis (NAA) with a lesion of the branches of the aortic
arch who were examined and treated at the State Institution "Republican
Specialized Scientific and Practical Medical Center for Surgery named after
academician V. Vakhidov" from 1978 to 2021. 300 patients with NAA with
lesions of the branches of the aortic arch were examined, 272 (90.7%) women
prevailed, 28 (9.3%) men, the average age was 31.06±0.53 years. Depending on
the approach to diagnosis and treatment, all patients with nonspecific
aortoarteritis of the branches of the aortic arch were divided into 2 groups.
Group I (comparison group) included patients admitted to the department in the
period 1978-2004, group II (main group) included patients who received
treatment in 2005-2021. There were 159 patients in group I and 141 patients in
group II (the main group). In group I, patients with NAA received
glucocorticosteroids, in the acute and subacute stages prednisone was used at
the rate of 1 mg / kg / day. In group II, during 2005-2021, treatment regimens
with pulse therapy with cyclophosphane and methylprednisolone and
prolonged administration of cytostatics and antiplatelet agents/anticoagulants
were used. Long-term results of surgical treatment were evaluated based on the
following parameters: cumulative patency of arteries, patency of shunts,
freedom from stroke, freedom from recurrence of upper limb ischemia, survival.
The duration of follow-up in the catamnesis was 63.1± 3.0 and 57.0±7.2 months
(p>0.05) in group I and II, respectively, a number of patients were followed for
16-20 years.
SOLUTION OF SOCIAL PROBLEMS IN
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The results and their discussion.
Complications of class II-V according to
Clavien-Dindo in the immediate postoperative period in patients with NAA were
observed in 5.97% of cases, mortality was 2.5% (5 cases). Surgical complications
were 3.6 times more common after intrathoracic interventions (p <0.05) than
after extrathoracic. Significantly more often surgical complications of class I-V in
the early period were observed in patients of group I (22.2% vs. 3.2%, p <0.05),
mainly in patients with acute and subacute stage of NAA at initial admission.
This indicates the low effectiveness of conservative treatment of
glucocorticosteroids. The use of conservative treatment regimens and a
personalized approach to choosing surgical tactics made it possible to increase
the cumulative patency of shunts: in the long-term period, the cumulative
patency of arteries in the first year of follow-up did not significantly differ in
both groups, amounting to 94.4% in group I and 98.6% in group II, respectively
(P>0.05), after 5 years of follow-up it was significantly better in Group II: 92.5%
vs. 69.7% (P<0.05), after 15 years it was also significantly better in group II:
82.7% vs. 52.6% (P<0.05). The use of a treatment strategy with the mandatory
appointment of pulse therapy, a personalized approach to the choice of tactics
and operational equipment individually proved its effectiveness, since the
immediate good result was 78.9% versus 51.8% with the traditional approach, a
good and satisfactory immediate result of treatment was 72 (86.7%) in group I
versus 75 (98.7%) in group II (p <0.05), it allowed to reduce the number of early
postoperative complications from 22.2% to 3.2%, reduce the number of
repeated operations from 15.7% (13 out of 83) to 2.6% (2 out of 76), increase
freedom from stroke from 82.8 to 97.7%, 10-year survival from 84.9% to 100%.
Conclusion.
The implementation of the developed treatment strategy made it
possible to reduce the number of early surgical complications and increase the
cumulative patency of the arteries after surgery in the long term.
