Akutes Aortensyndrom

Zusammenfassung

Das akute Aortensyndrom (AAS) ist eine vergleichsweise seltene aber oft lebensbedrohliche Ursache von akuten Thoraxschmerzen. Unter dem Begriff „AAS“ werden im engeren Sinne die akute Aortendissektion (AD), das intramurale Hämatom (IMH) und das penetrierende atherosklerotische Ulcus (PAU) zusammengefasst. Am häufigsten ist mit ca. 80 % die akute AD. Wichtigstes Merkmal der akuten AD ist ein plötzlich einsetzender Vernichtungsschmerz, der sich je nach Lokalisation in das Abdomen, den vorderen Thoraxbereich oder den Rücken projiziert, allerdings sind auch schmerzlose Verläufe möglich. Entscheidend für die Prognose sind eine rasche Diagnostik und Therapie. Zur definitiven Diagnose eignet sich die Kontrastmittel-angehobene CT-Untersuchung der Aorta, bei instabilen Patienten und in Anwesenheit erfahrener Untersucher ist auch die transösophageale Echokardiographie ein geeignetes Diagnoseverfahren. Typ A Dissektionen werden bevorzugt einer raschen chirurgischen Therapie zugeführt, bei komplizierten Typ B Dissektionen bietet sich eine endovaskuläre Behandlung („TEVAR – Thoracic EndoVascular Aortic Repair“) an. Unkomplizierte Typ B Dissektionen werden unter engmaschiger Beobachtung meist konservativ mit strikter Blutdruckeinstellung behandelt.

Abstract

Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU), in which the latter may progress to AD. Suddenly emerging severe pain localized in the chest, back or the abdomen is rather characteristic for acute AD, but painless courses of the disease are also possible. Rapid diagnosis and treatment are crucial for prognosis and survival. Aortic contrast-enhanced computed tomography is the method of choice due to its broad availability, distinguished accuracy and rapid feasibility. In instable patients, transoesophagel echocardiography by an experienced examiner is also applicable. Patients suffering from Type A AD need urgent surgery in most cases, patients.

Schlüsselwörter

akuter Thoraxschmerz - Aortendissektion - Akutes Aortensyndrom

Key Words

chest pain - aortic dissection - aortic syndrome

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