Die Behandlung der Aneurysmen der Extremitätenarterien – ein systematischer Überblick

Zusammenfassung

Aneurysmen der Extremitätenarterien haben eine geringe Inzidenz und manifestieren sich häufig durch Komplikationen. Schwerste Komplikationen sind die Ruptur und die extremitätenbedrohende Ischämie. Beide sind diagnoseführend. Eine absolute Therapieindikation besteht bei symptomatischen Aneurysmen und bei asymptomatischen ab einer Größe von 2,0 cm. Goldstandard ist extrailiakal das Interponat oder der Bypass mit venösem Graftmaterial. Endovaskuläre Methoden sind inoperablen Patienten vorbehalten und klinische Einzelfallentscheidungen. Im Gegensatz dazu sind komplexe endovaskukläre Techniken beim isolierten Iliakalaneurysma etabliert und haben die Behandlungsmöglichkeiten deutlich verbessert. Ihre Realisierung ist an die Existenz einer geeigneten Landungszone gebunden. Diese ist Grundlage einer neuen Klassifikation des isolierten Iliakalaneurysmas. Anhand morphologischer Subtypen ist mit dieser Klassifikation eine standardisierte Prozedurplanung zum Perfusionserhalt der A. iliaca interna möglich. Die vorliegende Arbeit gibt eine Übersicht über die aktuelle Behandlungsstrategie der Extremitätenarterienaneurysmen. Gemeinsamkeiten und regionale Unterschiede in der Therapie werden diskutiert.

Abstract

Aneurysms of arteries in the extremities have a low incidence and are often manifest through complications. The most serious complications are rupture and extremity-threatening ischemia. Both usually lead to the diagnosis. Absolute indications for therapy are symptomatic aneurysms and asymptomatic aneurysms of 2 cm diameter or more. The extrailiacal gold standard is interponat or bypass with venous graft material. Endovascular methods are reserved for inoperable patients and clinical decisions on special cases. In contrast, complex endovascular techniques have been established in isolated iliac aneurysms and have significantly improved treatment options. Their implementation is bound to the existence of a suitable landing zone. This is the basis for a new classification of isolated iliac artery aneurysm. With the help of morphological subtypes, this classification permits standardised procedure planning for perfusion preservation of the internal iliac artery. The present article gives an overview of the current treatment strategy for aneurysms of extremities arteries. Similarities and regional differences in therapy are discussed.

Schlüsselwörter

Aneurysmen der Extremitätenarterien - isoliertes Iliakalaneurysma - Therapieindikation - operative und endovaskuläre Therapie - Klassifikation des Iliakalaneurysmas

Key words

aneurysms of extremities arteries - isolated iliac artery aneurysm - therapy indication - surgical and endovascular therapy - classification of iliac artery aneurysm

Publication History

Article published online:
13 January 2020

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