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Notaufnahme up2date 2023; 05(01): 41-58
DOI: 10.1055/a-1526-4777
Thorax, Herz und Atemwege

Das akute Aortensyndrom

Artis Knapsis
1   Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
,
Jan David Süss
1   Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Zum akuten Aortensyndrom, das eine Konstellation lebensbedrohlicher Aortenwanderkrankungen beschreibt, zählen als Hauptentitäten die Aortendissektion, das intramurale Hämatom und das penetrierende Aortenulkus. Das Leitsymptom dieser Erkrankungen ist der akute Thoraxschmerz. Häufig sind die Symptome aber unspezifisch. Dadurch wird die Diagnosestellung in der Zentralen Notaufnahme erschwert. Eine rechtzeitige Diagnostik und Therapie sind für die Prognose des Patienten entscheidend.
Kernaussagen

  • Das akute Aortensyndrom ist eine potenziell lebensbedrohliche Erkrankung, die schnell diagnostiziert und therapiert werden muss.

  • Die häufigste Entität des akuten Aortensyndroms ist die Aortendissektion.

  • Die CT-Angiografie ist der Goldstandard der Diagnostik.

  • Die Patienten müssen bereits in der Notaufnahme hämodynamisch überwacht werden.

  • Das Initialmanagement besteht aus Analgesie (Opiate) und antihypertensiver Therapie mit intravenösen Betablockern und Nitraten.

  • Eine Typ-A-Aortendissektion muss unmittelbar chirurgisch therapiert werden.

  • Die unkomplizierte AD, IMH und PAU können konservativ behandelt werden.

  • Alle Patienten mit der Diagnose AAS müssen in ein Zentrum mit Expertise für thorakale Aortenpathologien verlegt werden.

Schlüsselwörter

Akutes Aortensyndrom - Aortendissektion - Intramurales Hämatom - Penetrierendes Aortenulkus


Publication History

Article published online:
10 January 2023

© 2022. Thieme. All rights reserved.

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