Die nicht-chirurgische Therapie des iatrogenen Aneurysma spurium

Zusammenfassung

Aneuysmata spuria kommen nach 0,1 - 1,5 % der diagnostischen Herzkatheteruntersuchungen und in bis zu 6 % nach perkutanen Interventionen vor. Während früher bei symptomatischen Patienten die Chirurgie die Therapie der Wahl darstellte, konkurrieren heute in erster Linie zwei nicht invasive Verfahren: die Ultraschall-gesteuerte Kompression (UGC) und die Ultraschall-gesteuerte perkutane Thrombininjektion (UGTI) in den Aneurysmasack. Die UGC ist nach 30 - 120 min Kompressionszeit im Mittel bei 80 % der nicht antikoagulierten Patienten erfolgreich. Sie erfordert aber einen längeren Krankenhausaufenthalt und ist oft schmerzhaft. Die UGTI ist auch bei antikoagulierten Patienten effektiv. Nach Injektion von 100 - 2000 U Thrombin kommt es im Mittel bei 95 % der Patienten zu einem Verschluss des Aneurysmas. Kontraindiziert ist die UGTI bei AV-Fisteln oder sehr großen Verbindungskanälen zum Nativgefäß. Patienten mit sehr ausgedehnten Hämatomen, fortschreitender Blutung, Verletzungen des Nativgefäßes, symptomatischer venöser oder arterieller Kompression, neurologischen Komplikationen oder Infektionen müssen frühzeitig operiert werden.

Summary

False aneurysms occur after 0.1 - 1.5 % of all diagnostic and up to 6 % of all therapeutic percutaneous interventions. Surgery used to be the treatment of choice in symptomatic patients. But two non-invasive measures of treatment gain more attention: ultrasound guided compression (UGC) and ultrasound guided thrombin injection (UGTI). UGC with compression times from 30 - 120 min is effective in 80 % of patients without anticoagulation. However, UGC is often painful and results in prolongation of in-hospital time. UGTI is effective in 95 % of patients. Usually, 100 - 2000 U of thrombin are injected into the false aneurysm. UGTI is also effective in the presence of anticoagulation or antiplatelet therapy. UGTI is not indicated in patients with a large communication with the native vessel and in arterio-venous-fistulas. In patients with large haematomas, ongoing bleeding, damage of the native vessel, compression of arteries, veins or neurological deficits, or with infections, early surgical repair is still the treatment of choice.

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