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.