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Kommentar zur 2014-Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnose und Therapie von Aortenerkrankungen

Comments on the 2014 guidelines of the European Society of Cardiology on the diagnosis and therapy of aortic diseases

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Der Kardiologe Aims and scope

Zusammenfassung

Erstmals fasst die Europäische Gesellschaft für Kardiologie in einer Leitlinie die Diagnose und Therapie von Erkrankungen der gesamten Aorta zusammen. Sie wünscht die Bildung von Aortenteams als Basis von Aortenzentren, die zukünftig europaweit zusammenarbeiten sollten. Im Vordergrund stehen die Diagnostik und Therapie der akuten Aortensyndrome, worunter die klassische Aortendissektion, das intramurale Hämatom, das penetrierende Aortenulkus, die traumatische Aortenruptur wie auch die iatrogene Aortenverletzung zusammengefasst werden. Ein diagnostischer Algorithmus für die Notaufnahme soll dazu beitragen, keine unnötigen diagnostischen Maßnahmen zu treffen und eine rasche Diagnosestellung zu ermöglichen als Basis für ein optimiertes therapeutisches chirurgisches und/oder interventionelles Verfahren. Für alle Kardiologen ist der Hinweis wichtig, dass bei Männern und Raucherinnen über 65 Jahren ein Screening auf ein abdominelles Aortenaneurysma durchgeführt werden soll, was z. B. im Anschluss an eine transthorakale Echokardiographie angeschlossen werden kann. Das therapeutische Vorgehen bei asymptomatischen und symptomatischen Patienten mit abdominellem Aortenaneurysma wird beschrieben. Ausführlich werden genetische Erkrankungen der Aorta sowie atherosklerotische und entzündliche Erkrankungen dargelegt. Wertvolle Hinweise gibt es für notwendige Verlaufsuntersuchungen im chronischen Stadium von Aortenerkrankungen.

Abstract

For the first time the European Society of Cardiology has presented guidelines for the diagnosis and therapy of aortic diseases involving parts as well as the total aorta. Desirable are the formation of aortic teams and the establishment of aortic centers, which should cooperate in a European effort. The diagnosis and therapy of acute aortic syndromes, including classical aortic dissection, intramural hematoma, penetrating aortic ulcer, traumatic aortic injury as well as iatrogenic aortic dissection are discussed and a diagnostic algorithm for emergency departments presented. The diagnostic algorithm should allow a rapid diagnosis and initiation of an optimal surgical and/or interventional therapy, not neglecting medical options . For cardiologists it is important to know that all men and women smokers > 65 years should be screened for the presence of an abdominal aortic aneurysm. Using transthoracic echocardiography a brief ultrasound scan of the abdominal aorta can be recommended as a screening method. The therapeutic options in asymptomatic and symptomatic patients with abdominal aortic aneurysms are described. Genetic diseases of the aorta as well as atherosclerotic and inflammatory diseases are listed. Important advice is given for follow-up studies in patients with aortic diseases.

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Authors and Affiliations

  1. Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    R. Erbel

  2. CCB – Cardioangiologisches Centrum Bethanien, Medizinisches Versorgungszentrum, Frankfurt am Main, Deutschland

    H. Eggebrecht

  3. Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland

    V. Falk

  4. Klinik für Thorax-, Herz-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    A. Haverich

  5. Royal Brompton Hospital, London, Großbritannien

    C. Nienaber

  6. Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland

    U. Sechtem

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  1. R. Erbel
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  2. H. Eggebrecht
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  4. A. Haverich
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  5. C. Nienaber
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Correspondence to R. Erbel.

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Additional information

Dieser Kommentar wurde koordiniert von C. Nienaber für die Kommission für Klinische Kardiologie der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V.

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Erbel, R., Eggebrecht, H., Falk, V. et al. Kommentar zur 2014-Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnose und Therapie von Aortenerkrankungen. Kardiologe 9, 348–353 (2015). https://doi.org/10.1007/s12181-015-0018-4

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