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Poplitealarterienaneurysma

Konventionelle und endovaskuläre Therapie

Popliteal artery aneurysm

Surgical and endovascular therapy

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Dieser Beitrag erschien ursprünglich in Gefässchirurgie (2012) 17:681-691; DOI s00772-012-1048-x.

Zusammenfassung

Die Arteria poplitea ist mit 70–80% die weitaus häufigste Lokalisation für ein peripheres Aneurysma. Ein Poplitealarterienaneurysma liegt vor, wenn der Durchmesser im erweiterten Segment dem doppelten Gefäßdurchmesser des vorgeschalteten bzw. nachgeschalteten Arteriensegments entspricht. Es tritt vornehmlich bei Männern jenseits des 65. Lebensjahrs auf (m:w = 20:1). Die Inzidenz liegt bei 0,5% und steigt mit zunehmendem Alter auf 1%. Zu 50–60% ist ein bilaterales Vorkommen zu verzeichnen, und in bis zu 50% ist ein abdominelles Aneurysma zu finden. Als Differenzialdiagnosen sind die Baker-Zyste, die zystische Adventitiadegeneration, ein Entrapmentsyndrom und ein epitheloides Hämangion zu nennen. Bei einem Drittel der diagnostizierten Poplitealarterienaneurysmen handelt es sich um Zufallsbefunde, während zwei Drittel symptomatisch (akute oder chronische Ischämie, lokale Kompression, Ruptur) auffällig werden. Die Indikation zur invasiven Therapie wird bei asymptomatischen Aneurysmen ab einer Größe von 2 cm sowie bei Nachweis eines Thrombussaums gestellt. Symptomatische Aneurysmen sind immer therapiebedürftig. Es kommen offen-chirurgische und zunehmend endovaskuläre Verfahren zum Einsatz. Wenige randomisierte Daten liegen vor; die Offenheitsraten unterscheiden sich im mittelfristigen Verlauf bei entsprechender Selektion nicht wesentlich.

Abstract

Aneurysms of the popliteal artery are the most common form of peripheral aneurysm with an incidence of 70–80 %. An enlargement of the popliteal artery of more than 50% of the original diameter is defined as a popliteal artery aneurysm and is found mainly in male patients older than 65 years of age. The incidence is 1%, in 50% of cases is bilateral and in up to 50% in association with other large vessel aneurysms (e.g. abdominal aorta). Differential diagnoses are Baker’s cyst, cystic adventitial disease, entrapment syndrome and epitheloid hemangioma. One third of all diagnosed popliteal artery aneurysms are asymptomatic incidental findings, whereas two thirds are conspicuous due to symptoms (acute or chronic ischemia, local compression, rupture). The indications for invasive treatment are given for patients with patent aneurysms at a diameter of more than 2 cm or if a thrombus is present within the aneurysm. Symptomatic popliteal artery aneurysms are always an indication for therapy. Treatment strategies are surgical techniques and endovascular interventions, which both have a similar outcome and graft patency in midterm results.

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  1. Gefäßchirurgische Klinik, Klinikum München Pasing, Lehrkrankenhaus LMU, Steinerweg 5, 81241, München, Deutschland

    R. Ghotbi & K. Deilmann

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  1. R. Ghotbi
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  2. K. Deilmann
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Correspondence to R. Ghotbi.

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Ghotbi, R., Deilmann, K. Poplitealarterienaneurysma. Chirurg 84, 243–254 (2013). https://doi.org/10.1007/s00104-013-2501-4

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