V.V. KATYNOV¹, L.N. IVANOV², O.E. LOGINOV¹, S.V. NAUMOV¹

¹Specialized cardiosurgical clinical hospital, 209 Vaneev St., Nizhny Novgorod, Russian Federation, 603950

²Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharskiy square, Nizhny Novgorod, Russian Federation, 603005

Katynov V.V. — physician of the 5^th Surgery Department, tel. (831) 417-75-88, e-mail: vkatynov@mail.ru¹

Ivanov L.N. — D. Med. Sc., Professor of the Department of Hospital Surgery named after B.A. Korolev, tel. (831) 417-75-88²

Loginov O.E. — Cand. Med. Sc., Head of the 5^th department of surgery, tel. (831) 417-75-88¹

Naumov S.V. — Cand. Med. Sc., physician and cardiovascular surgeon of the 5^th surgery department, tel. (831) 417-75-88, 417-75-191¹

The article presents the results of the study of intraoperative hemodynamic parameters in 41 patients with uncomplicated abdominal aortic aneurysm in conjunction with ischemic heart disease. The artivcle gives data on changes in blood pressure, heart rate, central venous pressure before aortic clamping, immediately after clamping, before restoration and after restoration of blood flow in the arteries of the lower limbs. The results of ECG monitoring in perioperative and postoperative periods are presented. Surgical techniques of preventing hemodynamic disorders were developed and applied, their effectiveness was evaluated. It is demonstrated that when making surgeries for abdominal aortic aneurysm hemodynamic changes cause myocardial ischemia, and the use of surgical techniques for preventing hemodynamic disorders significantly lowers the incidence of cardiac events. 

Key words: abdominal aortic aneurysm, ischemic heart disease, hemodynamics, myocardial ischemia.

 

REFERENCES

1. Pratesi C., Troisi N., Settembrini A.M. et al. Preoperative cardiac evaluation in patients undergoing aortic surgery. In: Setacci C., Gasparini D., Reimers B. et al. Aortic Surgery. New developments and perspectives. Turin. Edizioni Minerva Medica, 2009, pp. 75-84.

2. Kazanchyan P.O., Popov V.A. Oslozhneniya v khirurgii anevrizm bryushnoy aorty [Complications in surgery of abdominal aortic aneurysms]. Moscow: Izd-vo MEI, 2002. 304 p.

3. Spiridonov A.A., Arakelyan V.S., Tutov E.G, Sukhareva T.V. Khirurgicheskoe lechenie anevrizm bryushnoy aorty [Surgical treatment of abdominal aortic aneurysms]. Moscow: NTsSSKh im. A.N.Bakuleva RAMN, 2005. 294 p.

4. Krupski W.C., Layug E.L., Reilly L.M. et al. Comparision of cardiac morbidity rates between aortic and infrainguinal operations: two-year follow-up. Study of Perioperative Ishemia Research Group. J.Vasc.Surg., 1993, vol. 18, rr. 609-615.

5. L’Italien G.J., Cambria R.P., Cutler B.S. et al. Comparative early and late cardiac morbidity among patients requiring different vascular surgery procedures. J.Vasc.Surg., 1995, vol. 21, rr. 935-944.

6. Mackey W.C., O’Donnell T.F.J., Callow A.D. Cardiak risk in patients underground endoarterectomy: impact on perioperative and long-term mortality. J.Vasc.Surg., 1990, vol. 11, rr. 226-233.

7. Gul’muradov T.G. Diagnostika i khirurgicheskoe lechenie sochetannykh okklyuziruyushchikh porazheniy bryushnoy aorty i brakhiotsefal’nykh arteriy: avtoref. dis. … d-ra med. nauk [Diagnosis and surgical treatment of associated occlusive lesions of the abdominal aorta and brachiocephalic arteries. Synopsis of dis. PhD med. Sci.]. Moscow, 1988.

8. Hikmet Selcuk Gedik H.S., Korkmaz K., Erdem H. et al. Protective effect of heparin in the end organ ischemia/reperfusion injury of the lungs and heart. Journal of Cardiothoracic Surgery, 2012, vol. 7, 123 r.

9. Michael F. Roizen, Paul N. Beaupre, Ricki A. Alpert et al. Monitoring with two-dimensional transesophageal echocardiography: Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac, or infrarenal aortic occlusion. Presented at the Thirty-seventh Annual Meeting of the Society for Vascular Surgery, San Francisco, Calif., June 17-18, 1983.

10. Attia R.R., Murphy J.D., Snider M. et al. Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease. Circulation, 1976, vol. 53, rr. 961-965.

11. Brian G. Rubin, Gregorio A. Sicard. Abdominal Aortic Aneurysms: Open Surgical Treatment. In: Cronenwett J.L., Johnston K.W., ed. Rutherford’s Vascular Surgery, 7th ed. Philadelphia. Saunders. An Imprint of Elsevier, 2010, chapter 128.

12. Khubulava G.G., Sazonov A.B. Khirurgicheskoe lechenie anevrizm infrarenal’nogo otdela aorty [Surgical treatment of infrarenal aortic aneurysms]. Saint Petersburg, 2009. 144 p.

13. Sosudistaya khirurgiya po Khaymovichu: v 2 t. T. 2, pod red. E. Ashera; per. s angl. Pod red. A.V.Pokrovskogo [Vascular Surgery by Haimovich:in 2 vol. Vol. 2.Ed. E. Asher; lane. Translated from English. Ed. A.V.Pokrovsky]. Moscow: BINOM. Laboratoriya znaniy, 2010. 534 m.: il.

14. Bown M.J., Nicholson M.L., Bell P.R.F. et al. Cytokines and inflammatory pathways in the pathogenesis of multiple organ failure following abdominal aortic aneurysm repair. Europ. Journ. Vasc. Endovasc. Surg., 2001, vol. 22, rr. 485-495.

15. Norwood1 M.G.A., Bown M.J., Sutton A.J. et al. Interleukin 6 production during abdominal aortic aneurysm repair arises from the gastrointestinal tract and not the legs. British Journal of Surgery, 2004, vol. 9, rr. 1153-1156.

16. Walker P.M. Ischemia/reperfusion injury in skeletal muscle. Ann. Vasc. Surg., 1991, vol. 5, rr. 399-402.

17. Wozniak M.F., La Muraglia G.M., Musch G. Anesthesia for open abdominal aortic surgery. Int. Anesthesiol. Clin., 2005, vol. 43, rr. 61-78.

18. Anguissola G.B., Mangiarotti R., Pierini A. et al. Wall stress in the assessment of left ventricular function in surgery of abdominal aortic aneurism. Validity and importance of transesophageal echocardiography in intraoperative monitoring. Minerva Anestesiol., 1994, vol. 60, rr. 237-244.

19. Crawford E.S., Saleh S.A., Babb 3rd J.W. et al. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann. Surg., 1981, vol. 193, rr. 699-709.

20. Ernst C.B. Abdominal aortic aneurysm. N. Engl. J. Med., 1993, 328, rr. 1167-1172.

21. Hollier L.H., Rutherford R.B. Infrarenal aortic aneurism. In: Ruterford R.B., ed. Vascular surgery. 3rd ed. Philadelphia: W.B. Saunders, 1989. Rr. 909-927.

22. Sedov V.M., Vavilov V.N., Tokarevich K.K. et al. Upcoming surgery for aneurysms of the abdominal aorta. Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya, 2011, vol. 2, rr. 28-34 (in Russ.).

23. Ziad A. Ali, Chris J. Callaghan, Eric Lim at al. Remote ischemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair. A randomized controlled trial. Circulation, 2007, vol. 116, rr. 98-105.