Abdominal Aortic Pathology Surgery
Özet
Abdominal aortic aneurysm (AAA) is a permanent enlargement of the subdiaphragmatic aorta, commonly progressing asymptomatically and diagnosed incidentally through radiological imaging. Peak prevalence occurs between the seventh and eighth decades of life, with major risk factors including smoking, male gender, advanced age, hypertension, and family history. The pathophysiological mechanism involves chronic vascular inflammation, leading to medial layer degeneration and a significant decrease in key structural proteins such as elastin and collagen in the aortic wall. Elective surgical repair is strongly recommended when the aortic diameter reaches 5.5 cm or larger to prevent rupture. Open surgical repair aims to replace the aneurysm sac with a synthetic Dacron graft using either a transperitoneal or retroperitoneal approach. While the transperitoneal method provides rapid access, the retroperitoneal technique offers benefits such as shorter hospital stays and reduced postoperative complications. However, aortic cross-clamping can induce systemic vascular resistance increases, and its removal may cause sudden arterial hypotension. Potential complications of this surgery include hemorrhage, distal embolization, acute renal failure, ureteral injuries, and graft infections.
Referanslar
Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014 Nov 27;371(22):2101-8.
Sakalihasan N, Limet R., Defawe OD. Abdominal aortic aneurysm. Lancet. 2005 Apr 30-May 6;365(9470):1577-89.
Zommorodi S, Leander K, Roy J, Steuer J, Hultgren R. Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome. J Epidemiol Community Health. 2018 Oct;72(10):904-10.
Fattahi N, Rosenblad A, Kragsterman B, Hultgren R. Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm. J Vasc Surg. 2020 Oct;72(4):1337-1346.e1. doi: 10.1016/j.jvs.2019.11.062. Epub 2020 Feb 27.
Sweeting MJ, Thompson SG, Brown LC, Powell JT.; RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg. 2012 May;99(5):655-65.
Shaw PM, Loree J, Gibbons RC. Abdominal Aortic Aneurysm. 2021 Jan 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29262134.
Powell JT, Sweeting MJ, Brown, LC, Gotensparre SM, Fowkes FG, Thompson SG. Systematic review and meta-analysis of growth rates of small abdominal aortic aneurysms. Br J Surg. 2011 May;98(5):609-18.
Eliason JL, Hannawa KK, Ailawadi G, Sinha I, Ford JW, Deogracias MP, et al. Neutrophil depletion inhibits experimental abdominal aortic aneurysm formation. Circulation. 2005 Jul 12;112(2):232-40.
Busuttil RW, Rinderbriecht H, Flesher A, Carmack C. Elastase activity: the role of elastase in aortic aneurysm formation. J Surg Res. 1982 Mar;32(3):214-7.
Xu C, Zarins CK, Glagov S. Aneurysmal and occlusive atherosclerosis of the human abdominal aorta. J Vasc Surg. 2001 Jan;33(1):91-6.
Matsumoto T. Anatomy and Physiology for the Abdominal Aortic Aneurysm Repair. Ann Vasc Dis. 2019 Sep 25;12(3):329-33.
AboyansV, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al. Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018;55:305-68.
Schmitz-Rixen T, Keese M, Hakimi M, Peters A, Böckler D, Nelson K, et al. Ruptured abdominal aortic aneurysm-epidemiology, predisposing factors, and biology. Langenbecks Arch Surg 2016;401:275-88.
National Institute for Health and Care Excellence. Abdominal aortic aneurysm: diagnosis and management. NICE guideline NG156. Available at: https://www.nice.org.uk/guidance/NG156. [Accessed: March 20, 2020].
RESCAN Collaborators, Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA 2013;309:806-13.
Soden PA, Zettervall SL, Ultee KH, Darling JD, Buck DB, Hile CN, et al. Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg 2016;64:297-305.
Ten Bosch JA, Koning SW, Willigendael EM, Van Sambeek MR, Stokmans RA, Prins MH, et al. Symptomatic abdominal aortic aneurysm repair: to wait or not to wait. J Cardiovasc Surg (Torino) 2016;57:830-8.
Sicard GA, Reilly JM, Rubin BG, Thompson RW, Allen BT, Flye MW, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg. 1995 Feb;21(2):174-81; discussion 181-3.
Mei F, Hu K, Zhao B, Gao Q, Chen F, Zhao L, et al. Retroperitoneal versus transperitoneal approach for elective open abdominal aortic aneurysm repair. Cochrane Database Syst Rev. 2021 Jun 21;6(6):CD010373.
Borkon MJ, Zaydfudim V, Carey CD, Brophy CM, Guzman RJ, Dattilo JB. Retroperitoneal repair of abdominal aortic aneurysms offers postoperative benefits to male patients in the Veterans Affairs Health System. Ann Vasc Surg. 2010 Aug;24(6):728-32.
Ma B, Wang YN, Chen KY, Zhang Y, Pan H, Yang K. Transperitoneal versus retroperitoneal approach for elective open abdominal aortic aneurysm repair. Cochrane Database System Rev. 2016 Feb 5;2:CD010373.
Mehta T, Wade RG, Clarke JM. Is it safe to ligate the left renal vein during open abdominal aortic aneurysm repair? Ann Vasc Surg. 2010 Aug;24(6):758-61
Edward YW, Scott MD. (2014). AbdominalAortic Aneurysms: Open Surgical Treatment, Cronenwett, J.L., Johnston, K.W, Rutherford’s Vascular Surgery, (Section 21,8nd ed. ,pp.2024-2045). Philadelphia: Elsevier Saunders.
Ourel K, Rutherford RB. Atlas Of Vascular Surgery. Operative Procedures. Philadelphia. 1998.p.111-119
Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology. 1995 Apr;82(4):1026-60.
Hans SS, Vang S, Sachwani-Daswani G. Iatrogenic Major Venous Injury Is Associated with Increased Morbidity of Aortic Reconstruction. Ann Vasc Surg. 2018 Feb;47:200-4.
Wolpert LM, Dittrich KP, Hallisey MJ, Allmendinger PP, Gallagher JJ, Heydt K, et al. Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2001 Jun;33(6):1193-8.
Drazic OD, Zárate CF, Valdés JF, Krämer AH, Bergoeing MP, Mariné LA, et al. Juxtarenal Abdominal Aortic Aneurysm: Results of Open Surgery in an Academic Center. Ann Vasc Surg. 2020 Jul;66:28-34.
Awad H, Tili E, Nuovo G, Kelani H, Ramadan ME, Williams J, et al. Endovascular repair and open repair surgery of thoraco-abdominal aortic aneurysms cause drastically different types of spinal cord injury. Sci Rep. 2021 Apr 9;11(1):7834.
Cheng W, Chen Z, Tang XB, Wu ZM, Liu H, Kou L, et al. Clinical analysis of peri-operative gastrointestinal complications after endovascular and open repair of abdominal aortic aneurysm. Zhonghua Wai Ke Za Zhi. 2019 Aug 1;57(8):591-95.
Schaefers JF, Donas KP, Panuccio G, Kasprzak B, Heine B, Torsello GB, et al. Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair. Eur J Vasc Endovasc Surg. 2019 Jan;57(1):130-36.
Shitara K, Wada R. Gastrointestinal bleeding after aortic surgery: a case report. Cases J. 2009 Nov 23;2:9074.
Fortner G, Johansen K. Abdominal aortic aneurysms. WestJ Med. 1984 Jan;140(1):50-9.
Schermerhorn ML, Giles KA, Sachs T, Bensley RP, O'Malley AJ, Cotterill P, et al. Defining perioperative mortality after open and endovascular aortic aneurysm repair in the US Medicare population. J Am Coll Surg. 2011 Mar;212(3):349-55.
