Aortenaneurysma und -dissektion – Endovaskuläre Therapie

Abstract

Sowohl im thorakalen Abschnitt der Aorta als auch im Bereich der Aorta abdominalis werden zunehmend Endovaskularprothesen eingesetzt. So kann man über einen minimalinvasiven Zugang – meist über die A. femoraliscommunis – Aneurysmen ausschalten und damit eine spätere Ruptur verhindern. Auch Aneurysmarupturen und traumatische Aortenrupturen werden erfolgreich endovaskulär behandelt. Bei Stanford-B-Aortendissektionen setzt man Endovaskularprothesen zum Verschluss des proximalen Intima-Einrisses („Entry“) ein und verhindert dadurch die Perfusion des „falschen Lumens“, das weitere Wachstum des Aneurysma und die Ruptur des falschen Lumens. Die Erfolge der endovaskulären Therapie haben zur Entwicklung moderner Stentprothesen mit Seitenarmen sowie von fenestrierten Prothesen mit Aussparungen für abdominelle Gefäßabgänge geführt, die eine Versorgung von komplexen thorakoabdominellenAortenpathologien möglich machen. Endovaskuläre Eingriffe sind für Patienten mit ausgeprägter Komorbidität deutlich schonender als die alternativen offenen chirurgischen Verfahren. Perioperative Morbidität und Mortalität sinken.

Schlüsselwörter

Aortenaneurysma - Aortendissektion - Stent - Endovaskularprothese - Aortenruptur - Stentgraft

• Literatur

• 1 Brunkwall J, Hauksson H, Bengtsson H et al. Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence. J VascSurg 1989; 10: 381-384
• 2 Ayari R, Paraskevas N, Rosset E et al. Juxtarenal aneurysm. Comparative study with infrarenal abdominal aortic aneurysm and proposition of a new classification. Eur J VascEndovascSurg 2001; 22: 169-174
• 3 Lederle FA, Johnson GR, Wilson SE et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1425-1430
• 4 Jones A, Cahill D, Gardham R. Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery. Br J Surg 1998; 85: 1382-1384
• 5 Brewster DC, Cronenwett JL, Hallett Jr. JW et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J VascSurg 2003; 37: 1106-1117
• 6 Davies RR, Goldstein LJ, Coady MA et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann ThoracSurg 2002; 73: 27-18
• 7 Bavaria JE, Appoo JJ, Makaroun MS et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J ThoracCardiovascSurg 2007; 133: 369-377
• 8 Jacobs MJ, Mommertz G, Koeppel TA et al. Surgical repair of thoracoabdominal aortic aneurysms. J CardiovascSurg (Torino) 2007; 48: 49-58
• 9 Verhoeven EL, Tielliu IF, Ferreira M et al. Thoraco-abdominal aortic aneurysm branched repair. J CardiovascSurg (Torino) 2010; 51: 149-155
• 10 Akin I, Kische S, Ince H, Nienaber CA. Indication, timing and results of endovascular treatment of type B dissection. Eur J VascEndovascSurg 2009; 37: 289-296
• 11 Nienaber CA, Kische S, Rousseau H et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. CircCardiovascInterv 2013; 6: 407-416
• 12 Kaji S, Akasaka T, Horibata Y et al. Long-term prognosis of patients with type a aortic intramural hematoma. Circulation 2002; 106 (Suppl. 01) 248-252
• 13 Ganaha F, Miller DC, Sugimoto K et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation 2002; 106: 342-348
• 14 Orend KH, Kirchdorfer B, Sunder-Plassmann L. Traumatic rupture of the descending thoracic aorta. Ann Ital Chir 1996; 67: 23-25
• 15 von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia. Ann ThoracSurg 1994; 58: 585-593
• 16 Tang GL, Tehrani HY, Usman A et al. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta- analysis. J VascSurg 2008; 47: 671-675
• 17 Volodos NL. Historical perspective: The first steps in endovascular aortic repair: how it all began. J EndovascTher 2013; 20 (Suppl. 01) 13-23
• 18 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann VascSurg 1991; 5: 491-499
• 19 England A, Mc Williams R. Endovascular aortic aneurysm repair (EVAR). Ulster Med J 2013; 82: 3-10
• 20 Faruqi RM, Chuter TA, Reilly LM et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J EndovascSurg 1999; 6: 354-358
• 21 Anderson JL, Adam DJ, Berce M, Hartley DE. Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts. J VascSurg 2005; 42: 600-607
• 22 Stather PW, Wild JB, Sayers RD et al. Endovascular aortic aneurysm repair in patients with hostile neck anatomy. J EndovascTher 2013; 20: 623-637
• 23 Etezadi V, Katzen BT, Benenati JF et al. Retroperitoneal versus direct femoral artery approach for thoracic endovascular aortic repair access: a case-control study. Ann VascSurg 2011; 25: 340-344
• 24 Hinchliffe RJ, Ivancev K, Sonesson B, Malina M. „Paving and cracking“: an endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries. J EndovascTher 2007; 14: 630-633
• 25 Antoniou GA, El Sakka K, Hamady M, Wolfe JH. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J VascEndovascSurg 2010; 39: 683-690
• 26 Weale AR, Beckitt T, Collin N, Hardman J. Evidence for endovascular aneurysm repair in patients with highly angulated neck anatomy. J CardiovascSurg (Torino) 2012; 53: 433-445
• 27 Liaw JV, Clark M, Gibbs R et al. Update: Complications and management of infrarenal EVAR. Eur J Radiol 2009; 71: 541-551
• 28 Maleux G, Koolen M, Heye S. Complications after endovascular aneurysm repair. SeminInterventRadiol 2009; 26: 3-9
• 29 Zhang WW, Kulaylat MN, Anain PM et al. Embolization as cause of bowel ischemia after endovascular abdominal aortic aneurysm repair. J VascSurg 2004; 40: 867-872
• 30 Maleux G, Koolen M, Heye S, Nevelsteen A. Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts. J VascIntervRadiol 2008; 19: 1409-1412
• 31 Williams JB, Andersen ND, Bhattacharya SD et al. Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair. J VascSurg 2012; 55: 1255-1262
• 32 Tornqvist P, Resch T. Endoleaks after EVAR and TEVAR: indications for treatment and techniques. J CardiovascSurg (Torino) 2014; 55 (Suppl. 01) 105-114
• 33 Shah A, Stavropoulos SW. Imaging Surveillance following Endovascular Aneurysm Repair. Semin Intervent Radiol 2009; 26: 10-16