Science & Healthcare

Introduction. A problem of tactic determination of abdominal aortic aneurysm surgical treatment at combined pathology of carotid and coronary arteries remains actual and polyhedral, but it has no final solution yet.

Aim of research. To study effectiveness of therapeutical and stage-by-stage surgical correction of combined pathology of coronary and carotid arteries during open surgical repair of abdominal aortic aneurysm.

Methods: Calculation of selection rate carried out for regression analyses using PASS 200 programm, version 12.0.4. Retrospective and prospective nonrandomized clinical research of 262 patients after surgical treatment on abdominal aortic aneurysm in 1998-2015 study period were carried out, which were divided into 2 groups depending on tactics and method of surgical treatment. In 1 – control group 92 (35,1%) patients after open surgical repair of abdominal aortic aneurism with no surgical correction of cardiac and cerebral ischemia complication predictors, had been undergoing therapeutical treatment of combined pathology in arterial basin of heart and brain; this group has been created to establish predictors of complications. 2^nd group of patients or group of study – 170 (64,9%) patients after open surgical repair of abdominal aortic aneurysm with surgical correction of complication predictors, in which preliminary surgical correction of arterial pathology of heart and brain were preformed according to indications. Analysis of predictors of complication and mortality rate in 30 day period carried out by logistic regression; in 5 years of postoperative period analyzed by Cox regression with correction of Firth.

Results: In 30 days of postoperative period myocardial infarction developed in 7 (7,6%) cases, in 2^nd group of patients 1 (0,6%) (р=0,020); case of myocardial infarction; in 5 years of postoperative period in 4 (4,5%) cases in 1^st group and in 2 (1,2%) cases in 2^nd group. Stroke developed in 3 (3,3%) cases in 30 days of postoperative period in 1^st group of patients and in (1,2%) (р=0,317) cases in 2^nd group; in 5 years of postoperative period 4 (4,5%) cases in 1^st group and 3 (1,8%) cases of stroke in 2^nd group.

Conclusions: Preliminary surgical correction of coronary artery pathology (OR 0,068; 95% CI 0,005-0,443) and normal ejection fraction of left ventricle (OR 0,911; 95% CI 0,859-0,965) decreases risk of myocardial infarction development; internal carotid artery (ICA) stenosis (OR 1,145; 95% CI 1,052-1,246) increases risk of ischemic stroke in 30 days of postoperative period. Development of myocardial infarction influences on survival as in 30 days of postoperative period (RR 6,159; 95% CI 4,027-8,938), so in 5 years of postoperative period (RR 3,509; 95% CI 1,153-5,945); stroke development influences on 5 year survival rate of patients (RR 3,273; 95% CI 1,177-5,509).