Authors
Kitachev K.V.1, Sazonov A.B.1, Bedrov A.Ya.2, Volkov A.M.1, Yakovlev N.N.3, Khubulava G.G.1
1 «Military Medical Academy named S.M. Kirov», Saint-Petersburg
2 First St. Petersburg State Medical University named Acad. I.P. Pavlov, Saint-Petersburg
3 «Alexandrovskaya» Hospital, Saint-Petersburg
Abstract
Backgraund. In the late periods after reconstructive operations on the abdominal aorta patients are under the observation of vascular surgeons at the place of residence. The majority of such patients are representatives of older age groups. The ability to recognize and correct significant risk factors for complications during long-term dynamic observation of operated patients in time ultimately affects the quality and duration of their life.
Aims. To evaluate the long-term results of open reconstructive surgeries on the abdominal aorta and to determine the factors that change the quality of life and survival of operated patients in the long term.
Materials and methods. A non-randomized comparative retrospective continuous study of the quality of life and survival for up to 5 years after surgery was conducted. Depending on the type of pathology, patients were divided into 2 groups – with aortoiliac aneurysm (n = 166) and occlusive pathology of the terminal aorta and iliac arteries (n = 73). The assessment of remote results was carried out during an outpatient appointment.
Results. In the remote periods after open surgery, the quality of life was expressed by an improvement in the indicators (p < 0.05) of mental and physical condition and general health. Negative dynamics were noted on the emotional scale. By the end of the 5-year observation period, the difference in mortality between those operated on for abdominal aortic aneurysm and Leriche syndrome was 7.9% (AAA – 13.67%, Leriche syndrome – 21.60%) with statistically significant differences in the two survival curves (logrank < 0.01). Significant factors worsening survival were identified: emergency surgery (p < 0.01), chronic lung diseases (p < 0.01), kidney diseases (p < 0.01), progression of chronic lower extremity ischemia (p < 0.01).
Conclusions. The following factors have an adverse effect on 5-year survival in the remote period: emergency surgery, length of hospital postoperative period, chronic lung and kidney diseases, decompensation of chronic lower limb ischaemia with followed amputation. The statistical significance of cerebrovascular disease, heart rhythm disturbances and hypertension has not been confirmed. The impact of ischemic heart disease was not assessed due to the need for its surgical treatment.
Keywords: abdominal aortic aneurysm, Leriche syndrome, complications of open surgery, elderly and senile age, remote postoperative period.
References
1. Briskin BS, Puzin SN, Kostyuchenko LN. Surgical diseases in geriatrics. Moscow: Binom, 2006. 336 p. (In Russ.)
2. Mistry PK, Gaunay GS, Hoenig DM. Prediction of surgical complications in the elderly: Can we improve outcomes? As J Urol. 2017; 4(1): 44-9. doi: 10.1016/j.ajur.2016.07.001.
3. Rosenfeld ES, Macsata RA, Lala S, et al. Open surgical repair of juxtarenal abdominal aortic aneurysms in the elderly is not associated with increased thirty-day mortality compared with fenestrated endovascular grafting. J Vasc Surg. 2021; 73(4). 1139-47. doi: 10.1016/j.jvs.2020.08.121.
4. Khouli H, Astua A, Dombrowski W, et al. Changes in health-related quality of life and factors predicting long-term outcomes in older adults admitted to intensive care units. Critical Care Med. 2011; 39(4): 731-7. doi: 10.1097/CCM.0b013e318208edf8.
5. Savin VV. Comparison of quality of life indicators in elderly and senile patients with critical lower extremities ischemia after vascular reconstructive surgery and amputations. Angiology and Vascular Surgery. 2001; 7(1): 54-60. (In Russ.)
6. Stather PW, Sidloff D, Dattani N, et al. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Brit J Surg. 2013; 100(7): 863-72. doi: 10.1002/bjs.9101.
7. Arora S, Bahekar A. Complex endovascular repair of bilateral iliac artery stenosis and coexisting aneurysm. Cardiovasc Revasc Med. 2017; 18(7): 528-30. doi: 10.1016/j.carrev.2017.04.010.
8. Richarz S, Aghlmandi S, Zdoroveac A, et al. Open aneurysm repair in patients with concomitant abdominal aortic aneurysm and aorto-iliac occlusive disease is associated with a high mortality and surgical complication rate. Swiss Med Weekly. 2021; 151(10): 300-50. doi: 10.4414/smw.2021.w30050.
9. Daniel V, Gupta N, Raffetto J, McPhee J. Impact of coexisting aneurysms on open revascularization for aortoiliac occlusive disease. J Vasc Surg. 2016; 63(4): 944-48. doi: 10.1016/j.jvs.2015.10.062.
10. Lotto CE, Sharma G, Walsh JP, et al. The impact of combined iliac occlusive disease and aortic aneurysm on open surgical repair. J Vasc Surg. 2020; 71(6): 2021-028. doi: 10.1016/j.jvs.2019.08.249.
