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Intensivmedizin up2date 2016; 12(02): 199-212
DOI: 10.1055/s-0042-103120
Operative Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Endovaskuläre Aortenchirurgie – besondere Herausforderung für die perioperative Intensivmedizin

Dmitriy I. Dovzhanskiy
,
Moritz S. Bischoff
,
Katrin Meisenbacher
,
Dittmar Böckler
Further Information

Publication History

Publication Date:
20 April 2016 (online)

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Kernaussagen

  • Die endovaskulären Techniken spielen eine immer größere Rolle bei der Versorgung von Aortenerkrankungen.

  • Die Indikation zur Therapie eines Aortenaneurysmas ist von dessen maximalen Durchmesser und der Klinik abhängig.

  • Periprozedural sind die endovaskulären Techniken im Vergleich zu den offenen konventionellen mit wenigen Komplikationen und einer geringeren Mortalität assoziiert.

  • Besondere Herausforderungen an die perioperative Versorgung stellen Notfälle wie eine Aortenruptur sowie die Behandlung einer thorakoabdominellen Aortenerkrankung dar.

  • Zu den typischen intraoperativen Komplikationen gehören Verletzungen und Okklusionen der Zugangsgefäße sowie ein akzidenteller Verschluss aortaler Äste.

  • Zu den weiteren postoperativen Komplikationen zählen Kolonischämie, Myokardinfarkt und eine Verschlechterung der Nierenfunktion.

  • Eine spinale Ischämie tritt häufig bei der Überstentung der größeren aortalen Abschnitte auf, vorwiegend bei Operationen an der Aorta descendens.

 

  • Literatur

  • 1 Debus ES et al. Zur Behandlung des abdominellen Aortenaneurysmas in Deutschland. Gefässchirurgie 2014; 19: 412-421
    CrossrefPubMedSearch in Google Scholar
  • 2 Gschwendtner M. Endovaskuläre Therapie der abdominellen Aorta. Wiener klinisches Magazin 2014; 17: 10-21
    CrossrefPubMedSearch in Google Scholar
  • 3 Lederle FA et al. Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1117-1121
    CrossrefPubMedSearch in Google Scholar
  • 4 Olsson C et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 2006; 114: 2611-2618
    CrossrefPubMedSearch in Google Scholar
  • 5 Taylor Jr LM, Porter JM. Basic data related to clinical decision-making in abdominal aortic aneurysms. Ann Vasc Surg 1987; 1: 502-504
    CrossrefPubMedSearch in Google Scholar
  • 6 Gawenda M, Brunkwall J. Ruptured abdominal aortic aneurysm: the state of play. Dtsch Arztebl Int 2012; 109: 727-732
    PubMedSearch in Google Scholar
  • 7 Behrendt CA, Rieß HC, Heidemann F et al. Das abdominale Aortenaneurysma. Teil II: Therapie. Gefäßmedizin Scan 2015; 2: 71-87
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Kotelis D et al. Thorakales Aortenaneurysma. Chirurg 2012; 83: 395-406
    CrossrefPubMedSearch in Google Scholar
  • 9 Desai ND et al. Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection. J Thorac Cardiovasc Surg 2015; 149: S151-S156
    CrossrefPubMedSearch in Google Scholar
  • 10 Ruppert V et al. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg 2006; 44: 16-21
    CrossrefPubMedSearch in Google Scholar
  • 11 Cronenwett JL, Johnston W. Rutherfordʼs Vascular Surgery. London: Expert Consult; 2010
    Search in Google Scholar
  • 12 Blankensteijn JD et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005; 352: 2398-2405
    CrossrefPubMedSearch in Google Scholar
  • 13 De Bruin JL et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1881-1889
    CrossrefPubMedSearch in Google Scholar
  • 14 Greenhalgh RM et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364: 843-848
    CrossrefPubMedSearch in Google Scholar
  • 15 Lederle FA et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302: 1535-1542
    CrossrefPubMedSearch in Google Scholar
  • 16 Becquemin JP et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg 2011; 53: 1167-1173
    CrossrefPubMedSearch in Google Scholar
  • 17 Lubke T, Brunkwall J. Metaanalysis of EVAR versus open repair for patients undergoing elective repair of abdominal aortic aneurysms. Zentralbl Chir 2014; 139: 552-561
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Powell JT et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014; 348: f7661
    CrossrefPubMedSearch in Google Scholar
  • 19 IMPROVE Investigators. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. Eur Heart J 2015; 36: 2061-2069
    CrossrefPubMedSearch in Google Scholar
  • 20 Weigang E et al. Management von Patienten mit Aortendissektion. Dtsch Arztebl International 2008; 105: 639-645
    PubMedSearch in Google Scholar
  • 21 Nienaber CA et al. INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial – a prospective, multicenter, European randomized trial. Am Heart J 2005; 149: 592-599
    CrossrefPubMedSearch in Google Scholar
  • 22 van der Vliet JA et al. Hypotensive hemostatis (permissive hypotension) for ruptured abdominal aortic aneurysm: are we really in control?. Vascular 2007; 15: 197-200
    CrossrefPubMedSearch in Google Scholar
  • 23 Cho S, Haider SE, Makaroun MS. US multicenter trials of endoprostheses for the endovascular treatment of descending thoracic aneurysms. J Vasc Surg 2006; 43: 12A-19A
    CrossrefPubMedSearch in Google Scholar
  • 24 Criado FJ et al. Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 2005; 80: 857-863
    CrossrefPubMedSearch in Google Scholar
  • 25 Köllbel T et al. Alternative Zugangswege zur abdominellen und thorakalen Aorta bei Aortenstentbehandlungen. Gefäßchirurgie 2011; 16: 160-167
    CrossrefPubMedSearch in Google Scholar
  • 26 Bast TJ et al. Ischaemic disease of the colon and rectum after surgery for abdominal aortic aneurysm: a prospective study of the incidence and risk factors. Eur J Vasc Surg 1990; 4: 253-257
    CrossrefPubMedSearch in Google Scholar
  • 27 Kaiser MM et al. Ischemic colitis after vascular surgery reconstruction of an abdominal aortic aneurysm. Chirurg 1996; 67: 380-386
    PubMedSearch in Google Scholar
  • 28 Becquemin JP et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg 2008; 47: 258-263
    CrossrefPubMedSearch in Google Scholar
  • 29 Perry RJ et al. Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 48: 272-277
    CrossrefPubMedSearch in Google Scholar
  • 30 Meissner MH, Johansen KH. Colon infarction after ruptured abdominal aortic aneurysm. Arch Surg 1992; 127: 979-985
    CrossrefPubMedSearch in Google Scholar
  • 31 Bjorck M, Bergqvist D, Troeng T. Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery – 2930 operations from a population-based registry in Sweden. Eur J Vasc Endovasc Surg 1996; 12: 139-144
    CrossrefPubMedSearch in Google Scholar
  • 32 Johnson WC, Nabseth DC. Visceral infarction following aortic surgery. Ann Surg 1974; 180: 312-318
    CrossrefPubMedSearch in Google Scholar
  • 33 Klar E et al. Acute Mesenteric Ischemia: a Vascular Emergency (Akute mesenteriale Ischämie – ein vaskulärer Notfall). Dtsch Arztebl Int 2012; 109: 249-256
    PubMedSearch in Google Scholar
  • 34 Akyildiz H et al. The correlation of the D-dimer test and biphasic computed tomography with mesenteric computed tomography angiography in the diagnosis of acute mesenteric ischemia. Am J Surg 2009; 197: 429-433
    CrossrefPubMedSearch in Google Scholar
  • 35 Buth J et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg 2007; 46: 1103-1110
    CrossrefPubMedSearch in Google Scholar
  • 36 Kotelis D et al. Morphological risk factors of stroke during thoracic endovascular aortic repair. Langenbecks Arch Surg 2012; 397: 1267-1273
    CrossrefPubMedSearch in Google Scholar
  • 37 Skrinjar E et al. Kardiovaskuläres Risiko bei EVAR und offener Operation des nicht rupturierten abdominalen Aortenaneurysmas. Gefässchirurgie 2013; 18: 273-277
    CrossrefPubMedSearch in Google Scholar
  • 38 Stather PW et al. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg 2013; 100: 863-872
    CrossrefPubMedSearch in Google Scholar
  • 39 Pagenstert GI, Hintermann B, Valderrabano V. Unterschenkel, Kompartmentsyndrom. In: Engelhardt Lexikon Orthopädie und Unfallchirurgie. Heidelberg: Springer; 2015
    Search in Google Scholar
  • 40 Greenberg RK et al. Analysis of renal function after aneurysm repair with a device using suprarenal fixation (Zenith AAA Endovascular Graft) in contrast to open surgical repair. J Vasc Surg 2004; 39: 1219-1228
    CrossrefPubMedSearch in Google Scholar
  • 41 Willam C. Kontrastmittelinduzierte Nephropathie: Inzidenz, Bedeutung und Behandlung. Gefässchirurgie 2011; 16: 454-461
    CrossrefPubMedSearch in Google Scholar
  • 42 White GH et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 1997; 4: 152-168
    CrossrefPubMedSearch in Google Scholar
  • 43 Bisdas T et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg 2015; 61: 1408-1416
    CrossrefPubMedSearch in Google Scholar
  • 44 Verhoeven EL et al. Editor's Choice – Ten-year Experience with Endovascular Repair of Thoracoabdominal Aortic Aneurysms: Results from 166 Consecutive Patients. Eur J Vasc Endovasc Surg 2015; 49: 524-531
    CrossrefPubMedSearch in Google Scholar
  • 45 Czerny M et al. Mechanisms of symptomatic spinal cord ischemia after TEVAR: insights from the European Registry of Endovascular Aortic Repair Complications (EuREC). J Endovasc Ther 2012; 19: 37-43
    CrossrefPubMedSearch in Google Scholar
  • 46 Weigang E et al. Neurophysiological monitoring during thoracoabdominal aortic endovascular stent graft implantation. Eur J Cardiothorac Surg 2006; 29: 392-396
    CrossrefPubMedSearch in Google Scholar
  • 47 Etz CD et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Eur J Cardiothorac Surg 2015; 47: 943-957
    CrossrefPubMedSearch in Google Scholar
  • 48 Kotelis D et al. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg 2009; 50: 1285-1292
    CrossrefPubMedSearch in Google Scholar
  • 49 Patterson BO et al. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg 2014; 60: 1491-1497
    CrossrefPubMedSearch in Google Scholar
  • 50 Schurink GW et al. Spinal cord function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures. J Cardiovasc Surg (Torino) 2013; 54 (Suppl. 01) 117-124
    PubMedSearch in Google Scholar
  • 51 Wynn MM et al. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009; 49: 29-34
    CrossrefPubMedSearch in Google Scholar