Health  Vol.6 No.12 , June 2014
Can We Change a Look at Atherosclerotic Aortic Aneurism Treatment?
Abstract: In recent years, the increasing number of cardiologists and cardiac surgeons tend to think that surgical treatment of patients with atherosclerotic aneurisms does not fully comply with contemporary ideas of what the disease is. Some data show that early operations in the presence of this pathology are associated with an unreasonably high mortality. Additionally, the use of intra-aortic stents and grafts cannot principally affect the therapeutic efficacy. Therefore, more attention is paid to the development of conservative therapeutic approaches leaving surgery defeated without surgical treatment. Two groups of patients with similar descending thoracic aortic atherosclerotic aneurisms (DTAAA) and abdominal aortic aneurisms (AAA) were retro- and prospectively studied over a 2-year period. Control group (Comparison group), (63 patients) received common surgical treatment from 2009 to 2010 whereas Main group (121 subjects) received multifaceted medical treatment to remove inflammatory reactions, strengthen aortic wall and control its dilation from 2011 to 2012. Operative treatment was used only in case of potential aneurism rupture. The comparison of the two groups of subjects showed that 2-year all-cause mortality in control group was 20.6% while in the main group it amounted to 9.1% due to the similar incidence of aneurism ruptures and deaths associated with concomitant diseases. It suggests that the odds ratio (OR) of survival when using attenuated therapeutic approach to treating atherosclerotic aneurisms is 2.6-fold higher compared to conventional surgical approach. One of the principal factors contributing to a higher mortality when using traditional surgical approach was the presence of polyorgan pathology that required constant medical correction irrespective of therapeutic option (surgical or medical) used. Another important factor is aortic aneurism wall frailty. The development of mechanisms that would allow its strengthening is considered a principal challenge of cutting-edge medicine that should be based on studies of triggers, molecular genetic bases of aortic wall immune-depending inflammatory formation, the production of pro-inflammatory cytokines, metalloproteinase activity that damages elastin and collagen fibers.
Cite this paper: Krylov, V. , Mrochek, А. , Titov, L. , Gaiduk, V. , Reut, L. and Smaliakou, А. (2014) Can We Change a Look at Atherosclerotic Aortic Aneurism Treatment?. Health, 6, 1345-1351. doi: 10.4236/health.2014.612165.

[1]   Shirinbek, О. (2008) Infrarenal Abdominal Aneurisms: Modalities and Outcomes (Literature Review). Cardiovascular Disease Journal, 9, 50-57. (in Russian)

[2]   Hallett Jr., J.W. (1992) Abdominal Aortic Aneurysm: Natural History and Treatment. Heart Disease and Stroke, 1, 303-308.

[3]   Bokeria, L.А. (2010) Aortic Segment Thoracic and Thoracic Abdominal Aneurism Surgery: Guidelines for Practitioners.

[4]   Titov, L.P. (2007) Infections and Modern Medical Biotechnologies. First Meeting of Scientists in Belarus. Belaruskaya Nauka, Minsk, 163-167. (in Russian)

[5]   Restrepo, C.S., Jcazionez, D., Suri, R. and Vargas, D. (2011) Аortitis: Imaging Spectrum of the Infectious and Inflammatory Conditions of the Aorta. Radiographics, 31, 435-451.

[6]   Harrington, D.J. (1996) Bacterial Collagenases and Collagen-Degrading Enzymes and Their Potential Role in Human Disease. Infection and Immunity, 64, 1885-1891.

[7]   Milewicz, D.M. (2012) MicroRNAs, Fibrotic Remodeling, and Aortic Aneurysm. Journal Clinical Investigation, 2, 490-403.

[8]   Boersmа, E. (2005) Perioperative Cardiovascular Mortality in Noncardiac Surgery: Validation of the Lee Cardiac Risk Index. American Journal of Medicine, 118, 1134-1141.

[9]   Greenhalgh, R.M., Brown, L.C., Kwong, G.P., et al. (2004) EVAR trial Participants. Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1), 30-Day Operative Mortality Results: Randomised Controlled Trial. Lancet, 364, 843-848.

[10]   EVAR Trial Participants (2005) Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1). Randomised Controlled Trial, 365, 2179-2186.

[11]   EVAR Trial Participants (2005) Endovascular Aneurysm Repair and Outcome in Patients Unfit for Open Repair of Abdominal Aortic Aneurysm (EVAR Trial 2). Randomised Controlled Trial, 365, 2187-2192.

[12]   Rakitsky, P.F. (1973) Biological Statistics. Visheyshaya Shkola, Minsk, 319. (in Russian)

[13]   Plavinsky, S.L. (2005) Planning, Processing and Reporting of the Results Obtained from Biomedical Studies Using SAS. Biostatistika, SPb MAPO, 559. (in Russian)

[14]   Dahlof, B., Sever, P.S., Poulter, N.R., et al. (2005) ASCOT Investigators Prevention of Cardiovascular Events with an Antihypertensive Regimen of Amlodipine Adding Perindopril as Required versus Atenolol Adding Bendroflumethiazide as Required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT— BPLA): A Multicentre Randomised Controlled Trial. Lancet, 366, 895-906.

[15]   Kemma, А., John, Thomas, L.F. and Serrius Patrick, V. (2011) Cardiovascular Disease Edition. “ESC Guidelines” GEOTAR-Media, 1209-1248. (in Russian).

[16]   Ejiri, J., Jnoue, N., Tsucube, T., et al. (2003) Oxidative Stress in Pathogenesis of Thoracic Aortic Aneurysm: Protective Role of Statin and Angiotensin II Type I Receptor Blocer. Cardiovascular Research, 59, 988-996.

[17]   Vammen, S., Lindholt, J.S., Ostergaard, L., Fasting, H. and Henneberg, E.W. (2001) Randomized Double-Blind Controlled Trial of Roxithromycin for Prevention of Abdominal Aortic Aneurysm Expansion. British Journal of Surgery, 88, 1066-1072.

[18]   Jeffrey, A.J., Spinale, F.G. and Ikonomidis, J.S. (2009) Transforming Growth Factor-Beta Signaling in Thoracic Aortic Aneurysm Development: A Paradox in Pathogenesis. Journal of Vascular Research, 46, 19-37.

[19]   Nagasawa, A., Yoshimura, K., Suzuki, R., Mikamo, A., Yamashita, O., Ikeda, Y., Tsuchida, M. and Hamano, K.J. (2013) Important Role of the Angiotensin II Pathway in Producing Matrix Metalloproteinase-9 in Human Thoracic Aortic Aneurysms. Journal of Surgical Research, 183, 472-477.

[20]   Yoshimura, K. and Aoki, H. (2012) Recent Advances in Pharmacotherapy Development for Abdominal Aortic Aneurysm. International Journal of Vascular Medicine, 2012, Article ID: 648167.

[21]   Yoshimura, K., Aoki, H., Ikeda, Y., Furutani, A., Hamano, K. and Matsuzaki, M. (2006) Regression of Abdominal Aortic Aneurysm by Inhibition of c-Jun N-Terminal Kinase in Mice. Annals of the New York Academy of Sciences, 1085, 74-81.

[22]   Titov, L.P. (2012). Micro-RNA: New Class of Immune Response Regulatory Molecules and Infectious Process. Up-to-Date Challenges of Human Infectious Pathology, 5, 256-261. (in Russian)

[23]   Lederle, F.A., Wilson, S.E., Johnson, G.R., et al. (2002) Aneurysm Detection and Management Veterans Affairs Cooperative Study Group. Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysm. The New England Journal of Medicine, 346, 1437-1444.