vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2025.6.CASE.2vmireaviz-1545Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEКардиоваскулярные осложнения третичного сифилиса: разрыв аневризмы нисходящего отдела грудной аорты с последующим формированием аорто-пищеводного свищаCardiovascular complications of tertiary syphilis: rupture of the aneurysm of the descending thoracic aorta, followed by the formation of an aortoesophageal fistulahttps://orcid.org/0000-0001-8913-9321ЧернаяН. Р.ChernayaN. R.

Черная Наталья Рэсовна. Канд. мед. наук, старший научный сотрудник, врач по рентгенэндоваскулярным диагностике и лечению

Большая Сухаревская пл., д. 3, г. Москва, 129090

Natal'ya R. Chernaya. Cand. Sci. (Med.), Senior Researcher, endovascular surgeon 

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

https://orcid.org/0009-0008-5498-9287ЛосеваВ. В.LosevaV. V.

Лосева Валерия Владимировна. Студент Института биомедицины

ул. Островитянова, д. 1, г. Москва, 117513

Valeriya V. Loseva. Student of the Department of Biomedicine

Ostrovityanova St., 1, Moscow, 117513

https://orcid.org/0000-0002-2876-7997ГоршковН. С.GorshkovN. S.

Горшков Никита Сергеевич. Врач по рентгенэндоваскулярным диагностике и лечению

Большая Сухаревская пл., д. 3, г. Москва, 129090

Nikita S. Gorshkov. Endovascular surgeon

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

https://orcid.org/0000-0002-6989-831XСеляевВ. С.SelyaevV. S.

Селяев Владислав Сергеевич. Канд. мед. наук, младший научный сотрудник, сердечно-сосудистый хирург

Большая Сухаревская пл., д. 3, г. Москва, 129090

Vladislav S. Selyaev. Cand. Sci. (Med.), Junior Researcher, cardiovascular surgeon

 Bolshaya Sukharevskaya Square, 3, Moscow, 129090

https://orcid.org/0000-0001-5753-0043НиколаеваЕ. Б.NikolaevaE. B.

Николаева Елена Борисовна. Канд. мед. наук, старший научный сотрудник, торакальный хирург

Большая Сухаревская пл., д. 3, г. Москва, 129090

Elena B. Nikolaeva. Cand. Sci. (Med.), Senior Researcher, thoracic surgeon

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

https://orcid.org/0000-0002-3167-3692КоковЛ. С.KokovL. S.

Коков Леонид Сергеевич. Д-р мед. наук, академик РАН, руководитель научного отдела неотложной кардиологии и сердечно-сосудистой хирургии

Большая Сухаревская пл., д. 3, г. Москва, 129090

Leonid S. Kokov. Dr. Sci. (Med.), Academician of the Russian Academy of Sciences, Head of the Scientific Department of Emergency Cardiology and Cardiovascular Surgery 

Bolshaya Sukharevskaya Square, 3, Moscow, 129090

Научно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияSklifosovsky Research Institute for Emergency MedicineRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский Университет)РоссияRussian National Research Medical University named after N.I. Pirogov (Pirogov University)Russian Federation202510032026156181–193Copyright © Черная Н.Р., Лосева В.В., Горшков Н.С., Селяев В.С., Николаева Е.Б., Коков Л.С., 20262026Черная Н.Р., Лосева В.В., Горшков Н.С., Селяев В.С., Николаева Е.Б., Коков Л.С.Chernaya N.R., Loseva V.V., Gorshkov N.S., Selyaev V.S., Nikolaeva E.B., Kokov L.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/1545Актуальность

Актуальность. У 30% пациентов, заражённых сифилисом и не получающих лечение, спустя длительный период течения болезни выявляются осложнения, характеризуемые как третичный сифилис. Сосудистые поражения чаще всего манифестируют спустя 15–30 лет после установления носительства инфекции. Аневризма аорты – одно из редких проявлений кардиоваскулярного сифилиса. Ввиду того, что аневризма аорты является редко встречаемым осложнением у пациентов с сифилисом, важными являются своевременные диагностика и лечение.

Цель исследования

Цель исследования: проанализировать особенности диагностики, тактику хирургического лечения пациентов с сифилитической аневризмой аорты.

Материалы и методы

Материалы и методы. Описано клиническое наблюдение пациента с сифилитической аневризмой нисходящего отдела грудной аорты с признаками разрыва и формирования аорто-пищеводного свища. Анализ данных клинического наблюдения выполнен ретроспективно.

Результаты

Результаты. Пациент П. доставлен в клинику в апреле 2024 года по экстренным показаниям.  В течение двух недель пациента беспокоил кашель и ноющие боли в эпигастральной области. По результатам обследования установлен диагноз – аневризма грудной части аорты разорванная (I71.1). Пациенту выполнено сонно-подключичное шунтирование слева, эндопротезирование грудной аорты. При повторной госпитализации спустя полгода по данным эндоскопических исследований и компьютерной томографии установлено наличие аорто-пищеводной фистулы.

Выводы

Выводы. Выявление больных с сосудистыми осложнениями на фоне течения сифилиса представляет сложность. Отличительной особенностью сифилитической аневризмы аорты является её длительное бессимптомное течение, что затрудняет раннее выявление патологии и своевременное лечение. 

Relevance

Relevance. 30% patients who infected syphilis during the long time have got complications characterized as tertiary syphilis. Vascular complications often manifest after 15–30 years. An aortic aneurysm is one of the rare cardiovascular syphilis manifestation. Due to the fact that it is a rare complication, timely diagnosis and the correct treatment choice for such patients are important.

The aim of the study

The aim of the study. To analyze the diagnosis’ features and surgical treatment tactics for patients with syphilitic aortic aneurysm. Materials and methods. This paper describes a clinical case of a patient with ruptured syphilitic descending thoracic aortic aneurysm and signs of aortoesophageal fistula formation. The data analysis was performed retrospectively.

Results

Results. Patient P. was admitted to the clinic in April 2024. For two weeks he had been complaining of cough and epigastric pain. The examination revealed ruptured thoracic aortic aneurysm (I71.1). The patient underwent left carotid subclavian bypass surgery and thoracic endovascular aortic aneurysm repair. Six months later according to endoscopic examinations and computer tomography an aortoesophageal fistula was established.

Conclusion

Conclusion. Identification of patients with syphilitic vascular complications is difficult. A syphilitic aortic aneurysm feature is its long-term asymptomatic course, which makes it difficult to early detection and treatment.

аневризма грудной аорты [D017545]третичный сифилис [D013590 (Syphilis)]разрыв аневризмы [D017542 (Aortic Rupture)]аортопищеводный свищ [D016577 (Vascular Fistula)]сосудистые осложнения [D014652]эндоваскулярная коррекция [D057510 (Endovascular Procedures)]гематома средостения [D006406 (Hematoma)]кардиоваскулярный сифилис [D013592 (SyphilisCardiovascular)]стент-графт [D015607 (Stents)]сифилитический аортит [D001025 (Aortitis)]thoracic aortic aneurysm [D017545]tertiary syphilis [D013590 (Syphilis)]ruptured aneurysm [D017542 (Aortic Rupture)]aortoesophageal fistula [D016577 (Vascular Fistula)]vascular complications [D014652]endovascular repair [D057510 (Endovascular Procedures)]mediastinal hematoma [D006406 (Hematoma)]cardiovascular syphilis [D013592 (SyphilisCardiovascular)]stent graft [D015607 (Stents)]syphilitic aortitis [D001025 (Aortitis)]ReferencesCocora M, Nechifor D, Lazar MA, Mornos A. Impending Aortic Rupture in a Patient with Syphilitic Aortitis. 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The authors declare that there are no conflicts of interest present.