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Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2020; 07(01): 73-88
DOI: 10.1055/a-1092-4171
CME-Fortbildung

Therapie primärer Aneurysmen der Extremitätenarterien

Georg Jung
,
Maria-Elisabeth Leinweber
,
Daphne Gray
,
Wojciech Derwich
,
Marc Harth
,
Thomas Schmitz-Rixen
Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Dr. med. Georg Jung, Frankfurt am Main.
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Periphere arterielle Aneurysmen sind seltene Gefäßerkrankungen, die grundsätzlich an sämtlichen Gefäßen auftreten können. Für die Therapieplanung müssen insbesondere individuelle Behandlungskriterien wie die Morphologie des Aneurysmas, die anatomische Lokalisation, besonders in Bezug auf bewegliche Segmente, der Gefäßabstrom und der Allgemeinzustand des Patienten berücksichtigt werden.
Kernaussagen

  • Periphere arterielle Aneurysmen sind seltene Gefäßerkrankungen, bei denen das betroffene Gefäßsegment auf mindestens das 1,5-Fache des nativen Gefäßdurchmessers dilatiert ist.

  • Grundsätzlich können primäre Aneurysmen an sämtlichen arteriellen Gefäßen auftreten.

  • Die diagnostischen Verfahren umfassen neben der Duplexsonografie die CT- und MR-Angiografie sowie die digitale Subtraktionsangiografie. Von essenzieller Bedeutung ist es, im Rahmen der Diagnostik die Morphologie des Aneurysmas und die Zu- und Abstromverhältnisse möglichst exakt abzubilden.

  • Die häufigste Entität peripherer Aneurysmen sind Poplitealarterienaneurysmen, die eine hohe Koinzidenz mit Aortenaneurysmen haben. Im Rahmen von Bindegewebserkrankungen oder Autoimmunerkrankungen können periphere arterielle Aneurysmen gehäuft auftreten (Ehlers-Danlos-Syndrom, Marfan-Syndrom, Morbus Behçet).

  • Therapeutisch stehen als aktueller Therapiestandard offen chirurgische Verfahren zur Verfügung, aber auch endovaskuläre Therapieansätze sind beschrieben.

  • Aktuell bietet die Literatur aufgrund der Seltenheit der Erkrankungen keine gute Evidenz zum Vergleich beider Verfahren. Für das Poplitealarterienaneurysma zeichnet sich aufgrund von mehreren Registerstudien und Singlecenterstudien ab, dass bei strenger Patientenselektion die endovaskuläre Therapie ein vergleichbares Outcome zur offenen Therapie bieten kann, wenngleich die offene Chirurgie therapeutischer Standard bleibt.

  • Für die Therapieplanung arterieller Aneurysmen an den Extremitäten müssen individuelle Behandlungskriterien berücksichtigt werden, etwa

    • aneurysmabedingte klinische Symptomatik,

    • die Morphologie des Aneurysmas,

    • die anatomische Lokalisation, besonders in Bezug auf bewegliche Segmente,

    • der Gefäßabstrom und

    • der Allgemeinzustand des Patienten.

Schlüsselwörter

Gefäßchirurgie - periphere Aneurysmen - Poplitealarterienaneurysma - endovaskulär


Publication History

Article published online:
26 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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