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Endovaskuläre Therapie thorakaler Aortenaneurysmen

Endovascular therapy ot thoracic aortic aneurysms

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Zusammenfassung

Dilatative Erkrankungen der Aorta descendens und des Aortenbogens wurden früher meist offen-chirurgisch transthorakal, häufig unter Einsatz eines Linksherzbypasses, rekonstruiert. Inzwischen wurden die etablierten chirurgischen Standardverfahren an der thorakalen Aorta durch endoluminale Strategien ergänzt und erweitert. Insbesondere beim kardiopulmonalen Risikopatienten, nach vorausgegangenen kardiochirurgischen Eingriffen sowie beim Notfallpatienten im Stadium der Ruptur mit hämorrhagischem Schock sind die Ergebnisse der offenen Chirurgie noch unbefriedigend und mit einer hohen Morbiditäts- und Mortalitätsrate verbunden. Die präoperative Planung des endovaskulären Eingriffs stellt neue Anforderungen an die Bildgebung. Durch optimierte multiplanare Rekonstruktion können Implantationsstrategie und Therapieerfolg in der Nachsorge langfristig gesichert werden. Die endovaskuläre Behandlung von thorakalen Aortenläsionen geht mit niedriger Krankenhausmortalität und relativ niedriger Morbidität einher. Auch die Rupturrate endovaskulär versorgter Aneurysmen ist im Verlauf sehr niedrig. Problem der neuen Technologie ist die Haltbarkeit der Systeme im Langzeitverlauf. Deswegen ist eine engmaschige, lebenslange, klinische und bildgebende Nachsorge erforderlich, um auftretende Probleme rechtzeitig erkennen und beheben zu können.

Abstract

Experience with endovascular repair of abdominal aortic aneurysms has led to the development of minimally invasive techniques to treat thoracic aortic pathologies. Such inhomogenous diseases challenge surgeons to perform complex surgical repairs in high-risk patients. The minimally invasive nature of thoracic endografting provides an attractive alternative therapy, especially in patients deemed unfit for thoracotomy. A worldwide review of thoracic endografting demonstrates encouraging short and midterm outcomes with significant reductions in morbidity and early mortality and acceptable freedom from aneurysm related death. Close long-term surveillance and serial imaging studies will be crucial to discovering complications unique to thoracic endografting and to detecting device failure prior to the development of devastating clinical sequelae. As this technology matures, endovascular therapy may become the preferred initial therapy for many thoracic aortic lesions. More specific selection of patients may further reduce mortality and morbidity.

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Authors and Affiliations

  1. Abteilung für Gefäßchirurgie, vaskuläre und endovaskuläre Chirurgie, Gefäßzentrum, Ruprecht-Karls-Universität Heidelberg

    H. Schumacher, D. Böckler & J.-R. Allenberg

  2. Abteilung für Gefäßchirurgie, vaskuläre und endovaskuläre Chirurgie, Gefäßzentrum, Ruprecht-Karls-Universität Heidelberg, Kirschnerstraße 1, 69120 , Heidelberg

    H. Schumacher

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  1. H. Schumacher
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  3. J.-R. Allenberg
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Correspondence to H. Schumacher.

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Schumacher, H., Böckler, D. & Allenberg, JR. Endovaskuläre Therapie thorakaler Aortenaneurysmen. Gefässchirurgie 10, 203–220 (2005). https://doi.org/10.1007/s00772-005-0399-y

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  • DOI: https://doi.org/10.1007/s00772-005-0399-y

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