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HighlightsNo studies have been published comparing the treatment of abdominal aortic aneurysms in residents of the Central Asian region and Russia ≥80 years of age. Differences in the number of emergency and planned operations in the studied countries have been revealed. Thus, despite the predominance of planned operations in the total structure, the frequency of emergency operations related to AAA rupture is extremely high, which is associated with a large aneurysm diameter. In Tajikistan there is no difference in mortality between patients of different age groups, while in the Russian Federation this indicator is higher among persons up to and including 79 years of age. The number of comorbidities is high in both countries. AbstractAim. To analyse the demography, the structure of comorbidity and mortality in the treatment of patients with AAA with an age priority of study up to 79 and over 80 years old in Russia and Tajikistan.Methods. A retrospective, comparative study of patients with infrarenal AAA who underwent endovascular repair of abdominal aortic aneurysm (EAAA) or open AAA reconstruction during the period from 2011 to 2015 at the clinic of Russian State Medical University named after N.N. acad. I.P. Pavlov in Ryazan, Russia and in the RSCCS, Dushanbe, Tajikistan (2011–2017). The study included 226 patients, 60 from Dushanbe (Tajikistan) and 166 from Ryazan (Russia). The study examined age, gender, comorbidities: diabetes, coronary heart disease (CHD), hypertension, COPD, smoking, as well as abdominal aortic diameter and 30-day mortality.Results. There are significantly more male patients with AAA in both countries. The number of comorbidities (CHD, hypertension, COPD, diabetes) per patient reaches 2.30 in Russia and 2.35 in Tajikistan. The number of patients older than 80 years in Russia was 11.4% and in Tajikistan 23.7% of the total number of patients operated on for AAA. In all countries, patients with AAA, inclusive, up to 79 years of age are statistically significantly more than patients 80 years of age or older. There are statistically significantly more patients under 79 in Russia. The age of patients after 80 is statistically significantly higher among patients from Russia. The number of emergency operations in all countries is significantly lower than elective operations, but still emergency operations were performed in almost one third of cases. In the group of patients up to 79 years old, the smallest number of emergency operations due to aneurysm ruptures was found in Russia. In the group of patients aged 80 years old and over, the smallest number of elective surgeries was found in Russia. The AAA diameter in patients from the two countries did not differ statistically significantly and amounted to 60.0 [48.0; 75.0] and 57.0 [54.0; 61.5] mm. in RF and RT, respectively (p > 0.05). In the age category up to 79 years old, there were statistically significantly fewer men in Tajikistan than in Russia. However, in the category after 80 years old there are statistically significantly fewer men in Russia than in Tajikistan. In Tajikistan, there was no difference in mortality between ages, however, in the Russian Federation it is higher in patients up to 79 years of age inclusive.Conclusion. As the results of the study showed, the average age of all patients with AAA was elderly, and the number of patients older than 80 years was 11.4% and 23.4% in Russia and Tajikistan, respectively. The group of patients over 80 years of age, according to the criterion of average age, was older among patients from Russia. It is important that the number of emergency operations in all countries is significantly lower than planned, but emergency operations were performed in almost one third of cases. In addition, the number of high-risk comorbidities is high in both countries.
HighlightsNo studies have been published comparing the treatment of abdominal aortic aneurysms in residents of the Central Asian region and Russia ≥80 years of age. Differences in the number of emergency and planned operations in the studied countries have been revealed. Thus, despite the predominance of planned operations in the total structure, the frequency of emergency operations related to AAA rupture is extremely high, which is associated with a large aneurysm diameter. In Tajikistan there is no difference in mortality between patients of different age groups, while in the Russian Federation this indicator is higher among persons up to and including 79 years of age. The number of comorbidities is high in both countries. AbstractAim. To analyse the demography, the structure of comorbidity and mortality in the treatment of patients with AAA with an age priority of study up to 79 and over 80 years old in Russia and Tajikistan.Methods. A retrospective, comparative study of patients with infrarenal AAA who underwent endovascular repair of abdominal aortic aneurysm (EAAA) or open AAA reconstruction during the period from 2011 to 2015 at the clinic of Russian State Medical University named after N.N. acad. I.P. Pavlov in Ryazan, Russia and in the RSCCS, Dushanbe, Tajikistan (2011–2017). The study included 226 patients, 60 from Dushanbe (Tajikistan) and 166 from Ryazan (Russia). The study examined age, gender, comorbidities: diabetes, coronary heart disease (CHD), hypertension, COPD, smoking, as well as abdominal aortic diameter and 30-day mortality.Results. There are significantly more male patients with AAA in both countries. The number of comorbidities (CHD, hypertension, COPD, diabetes) per patient reaches 2.30 in Russia and 2.35 in Tajikistan. The number of patients older than 80 years in Russia was 11.4% and in Tajikistan 23.7% of the total number of patients operated on for AAA. In all countries, patients with AAA, inclusive, up to 79 years of age are statistically significantly more than patients 80 years of age or older. There are statistically significantly more patients under 79 in Russia. The age of patients after 80 is statistically significantly higher among patients from Russia. The number of emergency operations in all countries is significantly lower than elective operations, but still emergency operations were performed in almost one third of cases. In the group of patients up to 79 years old, the smallest number of emergency operations due to aneurysm ruptures was found in Russia. In the group of patients aged 80 years old and over, the smallest number of elective surgeries was found in Russia. The AAA diameter in patients from the two countries did not differ statistically significantly and amounted to 60.0 [48.0; 75.0] and 57.0 [54.0; 61.5] mm. in RF and RT, respectively (p > 0.05). In the age category up to 79 years old, there were statistically significantly fewer men in Tajikistan than in Russia. However, in the category after 80 years old there are statistically significantly fewer men in Russia than in Tajikistan. In Tajikistan, there was no difference in mortality between ages, however, in the Russian Federation it is higher in patients up to 79 years of age inclusive.Conclusion. As the results of the study showed, the average age of all patients with AAA was elderly, and the number of patients older than 80 years was 11.4% and 23.4% in Russia and Tajikistan, respectively. The group of patients over 80 years of age, according to the criterion of average age, was older among patients from Russia. It is important that the number of emergency operations in all countries is significantly lower than planned, but emergency operations were performed in almost one third of cases. In addition, the number of high-risk comorbidities is high in both countries.
INTRODUCTION: First type secondary endoleaks (EL) require quickest elimination, primarily using the endovascular methods. Despite the existence of a sufficiently large number of methods of their elimination, the results of treatment remain ambiguous. AIM: Analysis of our own experience of elimination of the first type ELs in patients after endoprosthetics of infrarenal abdominal aortic aneurysm. MATERIALS AND METHODS: The study is retrospective with prospective observation. All patients underwent computed tomography (CT) for identification of the type of EL and choosing a method of its elimination. The term first type secondary EL was understood as EL which developed in the long-term period after the primarily negative CT-angiography after endoprosthetic repair of the aorta. RESULTS: ELs of Ia type were diagnosed in 14 cases, in one case EL of Ib type was identified. On average, first type secondary ELs were identified in 34 months after the primary operation for endograft implantation. In 2 of 15 patients, EL were symptomatic. The elimination of the first type EL required an individualized approach in all cases. The main methods of elimination of the first type EL were: elongation using Jotec E-iliac (n = 1); coiling with implantation of Gore cuff and Chimney-stenting of the left renal artery (LRA; n = 2); implantation of Gore cuff (n = 4); reinforcement with Aptus EndoAnchors (n = 2); Cuff Gore implantation and LRA stenting by Chimney-technique (n = 1); implantation of Cuff Jotec and reinforcement with Aptus EndoAnchors (n = 1); aneurysmal sac coiling (n = 2); Gore cuff implantation with fixation with EndoAnchors and LRA stenting using Chimney-technique (n = 1). The technical success of EL elimination was 100% (in all cases, the success was confirmed by intraoperative angiography, as well as by CT angiography or ultrasound duplex scanning with contrast enhancement after surgery), there were no deaths. In the long-term period (from 6 to 60 months), re-interventions were performed in two cases, fatal outcome happened in one case, after a late open conversion for elimination of EL. CONCLUSION: In 13% of cases, first type ELs were symptomatic, and their elimination required individual approach with taking into account anatomical factors and the implanted graft. The medium-term results of the elimination of the first type EL are good, no fatal cases have been reported, and the number of reinterventions has reached 20%, which requires monitoring in the postoperative period.
The descriptions of two cases of aortic dissection with an atypical picture, erroneously regarded as a pulmonary pathology, are presented. A thorough analysis of the clinical picture and the timely use of imaging diagnostic methods made it possible to establish the correct diagnosis and select presented.
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