Surgical treatment of aneurysms of aortic arch branches and vessels of the upper extremities

Abstract

Aneurysms of theaortic arch branches and vessels of the upper extremities are dangerous and there is a high probability of mortality due to rupture of the aneurysm or stroke. The indication is surgical treatment, regardless of the age and size of the aneurysms. The frequency of deaths and strokes that occurred during operations for carotid artery aneurysms is about 2%, which is associated with distal embolism of intracerebral vessels and the contents of the aneurysm cavity. One of the most common causes of aneurysms of the branches of the aortic arch and vessels of the upper extremities are atherosclerosis, nonspecific aortoarteritis and posttraumatic aneurysms. The study included 38 patients with aneurysms of the branches of the aortic arch and arteries of the upper extremities operated in the vascular surgery department over the past 10 years, whose total age ranged from 19 to 76 years. There were 84% men, 16% women. Aneurysms of the carotid arteries and its branches (temporal artery) were diagnosed in 58%, subclavian arteries in 16%, arteries of the upper extremities in 26%. The size of aneurysms of the branches of the aortic arch and arteries of the upper extremities ranged from 2.5 cm to 10 cm. The average size is 6.3±1.8 cm. When choosing the method of treatment of aneurysms of the branches of the aortic arch and arteries of the upper extremities, preference was given to performing reconstructive operations without the use of additional materials, which were performed in 52% cases), in 13 of these cases, excision of a false aneurysm with stitching of the defect was performed, in 6 of these cases, resections of aneurysms with end-to-end anastomosis were performed. In 48% cases, operations with the use of synthetic materials and autovenous plastic surgery were performed, and endovascular interventions were also performed in 4 cases. The most frequent type of surgery performed is resection of an aneurysm with a lateral suture – 34% cases. Resection of the anastomosis aneurysm at the end of the arteries – 16%, and prosthetics – in 8% cases (synthetic alloprosthetics in one and with autovenous prosthetics in two cases). After resection of subclavian artery aneurysm due to large diastasis of blood flow, reconstruction was performed by bypass surgery or prosthetics. Arterial aneurysm resection with autovenous patch was performed in 13% cases, and with allosunting – in 8% cases. Excision of an aneurysm of the axillary artery on the left with the restoration of a synthetic patch – in 5% cases. Ligation of an aneurysm in the temporal artery was performed in 2 cases (5%), this type of operation was performed with an aneurysm of non-main vessels, as well as in vessels with collateral blood flow in the distal area of the vessels. Implantation of a stentgraft into the right subclavian artery – in 3 cases (8%). X-ray endovascular embolization of aneurysm – in 3% case. Positive results in the postoperative period were observed in 92% patients. One (3%) patient developed complications in the form of hematomas after aneurysm resection. In 5% cases - lymphorrhea after excision of a false aneurysm