ABDOMINAL AORTIC ANEURYSMS NOT SUBJECT TO SURGERY - WHAT IS THE ROLE OF CONSERVATIVE MEANS?
Abstract
The modern approach to the conservative treatment of abdominal aortic aneurysms is aimed at non-surgical aneurysms (small aneurysms, subaneurysmal aortic dilatation) in order to slow growth and prevent complications, primarily rupture. Most of the drugs used (statins, doxycycline, roxithromycin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers) show good results in the experiment, but not in real clinical practice. The most significant fact of recent years is the data on the effect of metformin on the stabilization of aortic aneurysmal transformation. Despite the evidence base, the correction of arterial hypertension and blood lipids is an obligatory element in the treatment of patients with aneurysms of all parts of the aorta. A healthy diet, moderate physical activity, and antiplatelets in patients with AAA reduce the risk of cardiovascular events, but not the rate of aneurysm growth.
About the Authors
A. A. Fokin
South Ural State Medical University
Russian Federation
Russian Federation
A. V. Makarov
South Ural State Medical University
Russian Federation
Russian Federation
References
1. Национальные рекомендации по ведению пациентов с аневризмами аорты. Российский согласительный документ. / Текст : электронный // Российское Общество ангиологов и сосудистых хирургов angiolsurgery.org. - 2013. - URL: https://www.angiolsurgery.org/recommendations/2013/recommendations_AAA.pdf (дата обращения: 27.10.2022)
2. Wanhainen A., Verzini F., Van Herzeele I. и соавт. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aortoiliac Artery Aneurysms // Eur. J. Vasc. Endovasc. Surg. - 2019. -Т.57, №1. - С.8-93.
3. Chaikof E.L., Dalman R.L., Eskandari M.K., и соавт. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm // J. Vasc. Surg. - 2018. - Т.67, №1. - С.2-77.
4. Abdominal aortic aneurysm: diagnosis and management // NICE guideline 2020 URL: https://www.nice.org.uk/guidance/ng156/resources/abdominal-aortic-aneurysm-diagnosisand-management-pdf-66141843642565 (дата обращения: 27.10.2022)
5. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Single Volume / Zipes D.P., Libby P., Bonow R.O., и соавт. – Elsevier, 2018. - 2128 с.
6. Oxford Specialist Handbooks in Surgery Vascular Surgery. 2nd ed / Hands L., Thompson M. - Oxford University Press, 2015. – 448 с.
7. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. // Sidawy A., Perler B. – Elsevier, 2019. – 2832 с.
8. Endovascular Interventions / Wiley J. M., Sanina C., Faries P. и соавт. - WileyBlackwell, 2019. – 328 с.
9. Vascular and Endovascular Surgery. A Companion to Specialist Surgical Practice / Loftus I., Hinchliffe R.J. – Elsevier, 2018. – 352 с.
10. Mechanisms of Vascular Disease: A Textbook for Vascular Specialists. 3rd ed. / Fritidge R. - Springer International Publishing, 2020. – 733 p.
11. Vascular Surgery: Principles and Practice. 4th ed. / Wilson S.E., Jimenez J.C., Veith F.J. и соавт. - CRC Press, 2016. – 950 pс
12. Ziegler K.R., Curci J.A. In patients with small AAA, does medical therapy prevent growth? // Difficult decisions in vascular surgery: An evidence-based approach. - Springer International Publishing, 2017. – С.37-48.
13. Newman J. D., Motiwala A., Turin A. и соавт. Abdominal Aortic Aneurysms // Diseases of the aorta. - Springer International Publishing, 2019. - С.199-216.
14. Лунева Е. Б., Малев Э. Г., Панкова И. А., Земцовский Э. В. Медикаментозная терапия при аневризме грудного отдела аорты // Артериальная гипертензия. - 2018. - Т.24, №3. - С.264-271.
15. Propanolol Aneurysm Trial Investigators. Propranolol for small abdominal aortic aneurysms: results of a randomized trial // J. Vasc. Surg. - 2002. -Т.35 №1. – С.72-79
16. Wilmink AB, Hubbard CS, Day NE, и соавт. Effect of propanolol on the expansion of abdominal aortic aneurysms: a randomized study // Br. J. Surg. – 2000.- Т.87, №4. – С.499.
17. Rooke T.W. Drugs that slow down or accelerate the growth of abdominal aortic aneurysms // Mayo Clinic - International Vascular Symposium 2011: Advances and Controversies in Vascular Medicine, Vascular Surgery and Endovascular Interventions. - Edizioni Minerva Medica, 2011. - С.210-211.
18. Baxter B.T., Terrin M.C., Dalman R.L. Medical Management of Small Abdominal Aortic Aneurysms // Circulation – 2008. – Т.117, №14. – С.1883-1889
19. McFadyen J., Peter K. Platelets in the Pathogenesis of Vascular Disease and Their Role as a Therapeutic Target // Mechanisms of Vascular Disease: A Textbook for Vascular Specialists. 3rd ed. - Springer International Publishing, 2020. – С.233-261.
20. Vammen S., Lindholt J.S., Ostergaard L. и соавт. Randomized Double-Blind Controlled Trial of Roxithromycin for Prevention of AbdominaI Aortic Aneurysm Expansion // Br. J. Surg. – 2001. – Т.88, №8. – С.1066-1072
21. Lindeman J.H., Abdul-Hussien H., van Bockel J.H. и соавт. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm: doxycycline selectively depletes aortic wall neutrophils and cytotoxic Т cells // Circulation – 2009. – Т.119, №16. – С.2209-2216.
22. Mosorin M., Juvonen J., Biancari F. и соавт. Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study // J. Vasc. Surg. – 2001. – Т.34, №4. - С.606-610.
23. Aboyans V., Bauersachs R., Mazzolai L. и соавт. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy // Eur. Heart J. – 2021. – Т.42, №39. – С.4013-4024.
24. Никоненко А.А. Медикаментозное лечение аневризмы брюшной аорты // Запорожский медицинский журнал – 2013. – Т.81, №6, С.28-31.
25. Evidence-based Therapy in Vascular Surgery / Debus Е.S., Grundmann R. - Springer International Publishing, 2017. – 285 с.
26. Kent K.C., Zwolak R.M., Egorova N.N. и соавт. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals // J. Vasc. Surg. - 2010.- Т.52, №3. – С.539-548.
Review
For citations:
Fokin A.A., Makarov A.V. ABDOMINAL AORTIC ANEURYSMS NOT SUBJECT TO SURGERY - WHAT IS THE ROLE OF CONSERVATIVE MEANS? Title in english. 2022;17(3):88-94. (In Russ.)
Views:
68
Email this article 