Тактика лечения пациентов с аневризмой брюшной аорты и сочетанным поражением почек
Abstract
To develop therapeutic approach of patients with abdominal aortic aneurysm (AAA) and renal disorders is a challenge. Both open surgical and endovascular methods of treatment for AAA have significant risks of operative complications and mortality. Having additive comorbidities the risks increase. Renal failure is a frequent result of AAA interventions, associated with high mortality. Though, in some cases aneurism is accompanied by combined renal injuries that increase risks of postoperative acute renal failure (ARF). ARF of any etiology has high mortality ranged from 50 to 80% in postoperative period. Mortality caused by ARF is also high and ranges from 60 to 90% after the operation. Patients, survived after AAA and complicated by ARF have low risk to become dialysis-dependent (17-23%) that followed by poor long-term prognosis. Operative treatment depends on increased risk of operating complications and mortality. The presence of initial renal pathology significantly influences on the method of choice (open surgical or endovascular) treatment. Strategic activities must be done to minimize surgical risks by optimization of renal functions during and after the operation. AAA surgery is also complicated by increased frequency of combined pathology (IHD, aortic calcification and coagulopathy, caused by conditioned uremia of platelet dysfunction). We resumed the data of literature for combined renal injury and AAA in the world: frequency of occurrence, risk factors and progression, approach for perioperative case management, general complications, frequency of mortality of various categories of patients and relationship of creatine level with renal failure development. The actuality of researches, dedicated to relationship of long-term results in treatment of patients with ACF is reasoned; the algorithm of management for this category of patients is developed.References
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