EXPERIENCE OF PROVIDING SURGICAL CARE IN PATIENTS WITH RUPTURE INFRARENAL AORTIC ANEURISM

Анотація

Infrarenal aortic aneurysm complicated rhexis more often we can see in our practice. Such type of patients usually come to emergency hospitals where their disease pattern changes so quickly and needs special lead-up to decisions and about the time for surgical treatment that needs special preparation and has its own specificity. Providing especial care to this category of patients better to effect in medical treatment and preventive care institutions with multidisciplinary team. Presented posthoc analysis results of treatment of 22 patients with complicated by aneurism rupture of abdominal aorta in period from 2015 to 2019. Complicating disorder s had 7 patients (31.8%). 2 patients (9%) with aneurysm 3^rd type A.V.  Pokrovsky grade during distention of iliac artery in the time of their exposure was severed common iliac vein. Usually arise fatal hemorrhage, but we found the method how to stop it quickly. In two cases, in the presence of occlusion of the iliac arteries on both sides, lower mesenteric artery was reimplanted into the prosthesis in order to revolute the intestine. More often we found saccular aneurysms -16, spindle-shaped-6. The diameter of the aneurysms ranged from 6 to 14 cm. Intraoperatively, a ruptured aneurysm was detected in 18 patients along the posterolateral wall of the aneurysm, in 3 ruptured anterior wall, and in one case a fistula was found in the inferior vena cava. Only in 5 patients the aneurysm did not pass to the iliac arteries, so it was possible to perform linear aortic prosthetics, in 14 cases one of the iliac arteries was dilated, therefore aortic-sphincter prosthesis was performed, and in 3 cases aneurysmal dilatation was noted on both iliac arteries. femoral braces.

In 19 patients there was a significant intraoperative blood loss of more than 2 liters. In 13 cases the bleeding was stopped, in 6 cases (mostly with rupture of the anterior wall and large defects) we used an occlusive balloon. One of the frequent complications of these operations is compartment syndrome in the early p / o period, which was observed in five patients.

15 (68.2%) patients were discharged from the hospital after surgery. In one case, a delayed hemorrhagic stroke was confirmed after 4 weeks on the background of a hypertensive crisis, which ended in the death of the patient. Assessing the results of surgical interventions for AIVA ruptures, it should be noted that the survival of patients depended on the time from probable rupture to surgery, and on the diameter of the aneurysm and the location of the rupture, the volume and rate of blood loss. In 2 cases (9%) with aneurysms of type 3 according to the classification of A.V. Pokrovsky at expansion of iliac arteries at allocation for the purpose of ligation of iliac arteries the iliac vein was damaged. In such cases, the iliac artery was crossed and a lateral vascular suture was applied to the vein at the marginal injury of the latter, then the prosthesis was passed through the vascular lacuna to the thigh and the distal anastomosis was sutured into the common femoral artery. Last 25 years we didn't use the ligature method in our practice. Satisfactory results ware noted 15 times (68.2%). Complications arose in 7 (31.8%) cases. Mortality amounted to 7 cases (31.8%). If to analyze the causes of mortality, heart failure holds first place. The prognosis in this group of patients depends from a lot of factors, first of all, compensatory abilities, degree of hypovolemic conditions and the program for their compensation.