| dc.description.abstract | Within the last few years, there has been a strong trend to rethink the issue of management of
atherosclerotic descending thoracic and abdominal aortic aneurysms (AAAs). When etiopathogenetic
associations among changes observed during the progression of the disease were not fully
described, surgeons had successfully applied, although traumatic, but a rather radical method to
rescue from the rupture threat. As we gained experience and knowledge about long-term outcomes,
mostly concerned mortality, we realized that surgery could not be the main tactical approach to
AAAs treatment due to its frequent inefficiency and failure to guarantee that the disease would be
suppressed including co-morbidities, polymorphic processes and clinical manifestations. It all required
more sparing treatment strategies. The situation gave rise to a more argumentative and
sparing medical-and-surgical approach to treatment based on a more in-depth understanding of
the etiopathogenesis of the disease whereas surgery would remain of prime importance when appropriate.
The following has been developed to improve treatment outcomes for AAA: 1) Multifactorial
determination of indications for surgical correction with outlining the area of relative
and absolute risk of aneurysm rupture; 2) Method of conservative treatment aimed to attain and
maintain optimal blood pressure, target levels of cholesterol and low-density lipoproteins, as well
as reduce oxidative and inflammatory processes in aorta, strengthen its wall, stabilize the disease
and control co-morbidities. A four-year follow-up of patients using this developed technology has
yielded more preferred results suggesting the need for narrowing indications for surgery to treat
AAAs. Another advantage of the sparing approach to treat AAA is economic, due to fewer operations
and implantations of stent-grafts, considering the fact that medical treatment should be used
in operated subjects, too. | en_US |
