2. Etiology of the aorta and
its branches impairment
1. Atherosclerosis
2. Non-specific
aorto-arteritis
3. Pathological twisting
a and arterial deformation
4.Fibro-muscular displasia
Severe atherosclerosis
and a recent thrombus
in the narrowed lumen
Sign of
“beads”
Absence of elastic framework of media with
“bald” formation. Significant secondary
intimal hyperplasia with narrowing of the
lumen
3. Non-specific aorto-arteritis (NAA)
is a polyetiological autoimmune disease of
hypersensitive slowed or mixed type with
primary involvement of media and adventitia of
the aorta and the sites of branching major
arterial vessels from it.
NAA occurs due to alteration of body reactivity
to various external and internal stimuli because
of ecological situation contacts with living and
professional allergens.
In NAA due to autoimmune process sharp
thickening of media and adventitia of the aorta
and it’s branches occurs. Vasa-vasorum are
obliterated. Elastic framework is destroyed.
4. Classification of NAA
1. Disease stage.
2. Morphological changes.
3. Localization.
4. Stage (degree) of organ
ischemia (it is determined
for each organ separately).
5. Diagnostics of non-
specific aorto-arteritis
Physical examination
of a patient (palpation of
vessels, measurement of
arterial blood pressure
on arm, auscultation of
vessels, observation of
the eye fundus)
Reoencephalography
Typical points of
vessel auscultation
6. General principles of
management of NAA
The first principle – treatment of NAA is a
complex problem. Surgical and conservative
methods of treatment are not an alternative.
They complete each other.
The second principle – the main task of
conservative treatment is the most frequent
and reliable reduction of the inflammatory
process.
The third principle – surgery is indicated in
patient with significant hemodynamic damages
of CCA, vasorenal hypertension, coarctation,
aneurysms and insufficiency of aorta
7. General principles of
management of NAA
The fourth principle – Surgical treatment must be
provided in the stage of laboratorial and morphological
remission/ Operation is necessary to fulfil in three months
after normalization of the laboratorial data.
The fifth principle – the choose of surgery is determined
by localization and form of the damage of aorta and main
arteries.
The sixth principle – in cases of late complications
reconstructive surgery is indicated.
The seventh principle – the patients with NAA should be
on the dispensary (not less than once in 6th months with
determination of process activity and conduction of
duplex scanning.
The eighth principle – It is necessary to provide
antiinflammatory therapy in cases of process
exacerbation ( refresher course of pulse therapy and
maintaining doses of methotrexate .
8. Conservative treatment of NAA
Hypotensive therapy
Methods of antiinflammatory
therapy
Treatment by glucocorticoids (0,5-1
mg/kg/day
Method of pulse therapy (3000 mg 6-
methylprednisolonum, 1000 mg cyclophosphan
during 3 days)
Treatment by cytostatics (metatrexat 0,15
-0,35 mg/kg/every week)
9. Surgical treatment of NAA
Indications: significant hemodynamic
damages of CCA, vasorenal hypertension,
coarctation, aneurysms and insufficiency
of aorta
Contrindications : Presence of active
inflammatory process . Operation must
not be performed less than three months
after reduction of inflammation. The terms
less than 3 month after myocardial
infarction or stroke and terminal stage of
heart o kidney-liver impairment are
contrindications for surgery
10. Etiological reasons
Atherosclerosis, NAA, exstravasal
compression, pathological twisting,
syphilitic aortitis, fibro-muscular
displasia
Clinical picture of occlusive –
stenotic impairments of aortic
arch branches
- Ischemia of brain
- Ischemia of eyes
- Ischemia of upper limbs
Damages in NAA
Atherosclerotic
damages (proximal type)
Distal type
11. Stenosis of internal carotid artery more than 70%
regardless to clinical manifestations (including
asyptomatic).
Stenosis of 60%- 70% of the internal carotid artery
with the presence of heterogenic ulcerated plaque
and proved ischemic attacks in the pool of the
affected artery.
Hemodynamically significant pathological twisting or
deformity of the internal et common carotid et
vertebral arteries.
The operation is indicated to the patients undergone
ischemic stroke (cerebrovascular accident) with the
presence of more than 70% carotid stenosis not
earlier than 3 month in case of preserving mild
neurological deficit or its regression.
12. Acute stroke (insult)
Multiple hemodynamically
significant stenosis of
intracranial arteries
Rough neurological deficit
Large cerebral cyst (according
to the data of CT or MRI
13. The complexity of the
performance reconstructive
operations on the aortic arch
branches is due to necessity of
brain vitality preservation with
clamping carotid arteries. In such
situation retrograde pressure
must not fall less than 60 mm Hg
(40% of the systemic one) brain.
14. In addition to temporary bypass of cerebral
bloodflow the ways of brain protection
against ischemia include some others :
Craniocerebral hypothermia
Controlled hypertension
Performanceof operation in the
conditions of general
hyperoxybarotherapy
Pharmacological brain protection
15. Arterial aneurysms are localized dilation
of blood vessels caused by a congenital or
acquired weakness in the media. The wall
of an aneurysm is formed by the stretched
remnants of the arterial wall.
Aneurysm is a limited or diffuse dilation of a
vessel as much as more than 2 (more than 2
fold) exceeding its normal diameter with the
formation of the cavity inside the wall or in the
vessel’s surrounding connected with its lumen
Atherosclerotic aneurysm of the abdominal aorta.
The aorta below the renal arteries is ballooned to
form a prominent abdominal aneurysms
Aneurysm of the aorta
and other arteries are
found in as many as 10%
of autopsies
16. Clinical picture of uncomplicated
aortic aneurysms: 1 Pain; 2 Signs
of compression of adjacent organs.
The aneurysms of the thoracic aorta are characterised by:
1. Syndrome of superior vena cava
2. Horner’s syndrome
3. Constriction (squeezing) of the thoracic
lymphatic duct - swelling of the upper part of the
trunk.
4. Formation of kyphosis
The aneurysms of the abdominal aorta are characterised by
typical and indirect signs : typical signs – pulsating mass,
abdominal pain, systolic murmur above the mass;
indirect signs – abdominal, urological, ischioradicular
syndrome, syndrome of chronic ischemia of the lower
limbs
17. According to a roentgenological
picture aneurysms with the diameter
•Up to 3-5 cm are considered small
•Up to 5-7 cm are considered moderate
•Up to 7-16 cm are considered large
•More than 16 cm are considered gross
Surgical treatment of aneurysms
The patients with aneurysms of the abdominal
aorta are indicated to a surgical treatment.
The operation must be performed to patients of
any age with aneurysms of various localization
when the distension of the aorta is as much as
2 it’s diameter exceeds 4 cm. Unfavorable
prognosis sign enlargement of aneurysm
diameter more than by 0,4 cm a year
