Atherosclerotic lesions of the supra-aortic arteries are mainly localized in the carotid artery bifurcations – 57%, the subclavian artery – 18%, the vertebral arteries – 14%, the brachiocephalic trunk and the common carotid artery – 11%.
Objective. Theobjective of the research was to systematize the principles of surgical treatment of patients with atherosclerotic lesions of the supra-aortic arteries taking into consideration their polymorbidity and the multicentricity of atherosclerosis.
Materials and methods. The results of surgical reconstruction of the supra-aortic arteries in 468 patients were analyzed.All the patients were divided into two groups.Group I included 276 (59%) patients with previous surgical or endovascular intervention on any vascular territory for treatment of atherosclerotic lesions being admitted to the hospital for elective surgery on the extracranial arteries.Group II included 192 (41%) patients without previous surgical and invasive treatments of arterial pathology being hospitalized for surgery on the supra-aortic arteries.
Results. In Group I, according to the objective and clinical methods of examination, the patients’ condition was more critical due to somatic and intraoperative risk. When analyzing the results of postoperative complications there was no statistically significant difference between both groups (p<0.05).The overall rate for serious complications (acute cerebrovascular disease and myocardial infarction) in both groups was 3.4%; the mortality rate was 1.1%.
Conclusions. 1. Approximately 87% of surgical reconstructions of the aortic arch branches are aimed at the prevention of acute cerebrovascular disease. 2. Surgical treatment of atherosclerotic lesions of the supra-aortic arteries allows us to achieve good postoperative results (the overall rate for serious complications – 3.4%, the mortality rate –1.1%).
Karpenko AA, Starodubtsev VB, Chernyavskiy MA, et al. Hybrid operative interventions in multilevel lesions of the brachiocephalic arteries in patients with cerebrovascular insufficiency. Angiologiya i sosudistaya khirurgiya. 2010;16:4-6.
Rusyn VI, Korsak VV, Butsko YeS, Holiaka AH. Opportunity of endovascular treatment of atherosclerotic disease of extracranial arteries in acute period of ischemic stroke. Naukovyi visnyk Uzhhorodskoho universytetu. 2014;1(49):144-149.
Nikonenko AS, Gubka AV, Pertsov VI, et al. Possibilities of diagnostics and surgical treatment of extracranial arterial pathology. Klinichna khirurhiia. 2004;4:97-98.
Akhmedov AD, Usachev DYu, Lukshin VA, et al. Carotid endarterectomy in high-risk surgical patients. Voprosy neyrokhirurgiyi. 2013;77(4):36-41.
Adraktas DD, Brasic N, Furtado AD, et al. Carotid atherosclerosis does not predict coronary, vertebral, or aortic atherosclerosis in patients with acute stroke symptoms. Stroke. 2010;41(8):1604-1609. http://doi.org/10.1161/STROKEAHA.109.577437 PMid:20595672 PMCid:PMC2941092
Liu J, Martinez-Wilson H, Neuman MD, et al. Outcome of Carotid Endarterectomy after Regional Anesthesia versus General Anesthesia: A Retrospective Study Using Two Independent Databases. Transl Perioper Pain Med. 2014;1(2):14-21. PMid:26023678 PMCid:PMC4444227
Cho J, Lee KK, Yun WS, et al. Selective shunt during carotid endarterectomy using routine awake test with respect to a lower shunt rate. Korean Surg Soc. 2013;84(4):238-244. http://doi.org/10.4174/jkss.2013.84.4.238 PMid:23577319 PMCid:PMC3616278
Tonev A, Dimitrov S, Zahariev T, Nachev G. Surgical strategy for patients undergoing carotid endarterectomy. Khirurgiia (Sofiia). 2013;(3):48-55. PMid:24459766
Stilo F, Spinelli F, Martelli E, et al. The sensibility and specificity of cerebral oximetry, measured by INVOS - 4100, in patients undergoing carotid endarterectomy compared with awake testing. Minerva Anestesiol. 2012;78(10):1126-1135. PMid:23059517
Greene NH, Minhaj MM, Zaky AF, Rozet I. Perioperative management of carotid endarterectomy: a survey of clinicians' backgrounds and practices. J Cardiothorac Vasc Anesth. 2014;28(4):1126-1135. http://doi.org/10.1053/j.jvca.2013.11.007
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