Der Anaesthesist

, 57:782

Traumatische thorakale Aortenruptur

Präklinische Beurteilung, Diagnostik und Therapieoptionen
  • R. Kopp
  • J. Andrassy
  • S. Czerner
  • A. Weidenhagen
  • R. Weidenhagen
  • G. Meimarakis
  • M. Reiser
  • K.W. Jauch
Notfallmedizin

Zusammenfassung

Die traumatische thorakale Aortenruptur stellt eine lebensbedrohliche Verletzung der Aorta dar, die als Begleitverletzung nach stumpfem Thoraxtrauma oder im Rahmen eines Polytraumas vorkommen kann. In Abhängigkeit vom Ausmaß der Zerreißung der Aortenwand ist diese Gefäßverletzung mit einer hohen primären Letalität und einem relevanten sekundären Rupturrisiko im weiteren Verlauf verbunden. Bei der präklinischen Beurteilung können der linksthorakale Schmerz, ein abgeschwächtes linksseitiges Atemgeräusch mit zunehmender Dyspnoe und Tachykardie sowie ein abgeschwächter Puls an den unteren Extremitäten entsprechend einer Pseudokoarktation Hinweise für eine thorakale Aortenruptur geben. Die präklinische Therapie besteht in der Stabilisierung der Vitalfunktionen und der Behandlung des möglichen Schockzustands. Während die offene operative Therapie der traumatischen Aortenruptur bisher vorwiegend durch Direktnaht oder Gefäßinterponat mit kurzer Abklemmung der thorakalen Aorta oder extrakorporaler Zirkulation durchgeführt wurde, gewinnt die endovaskuläre thorakale Stentgraft-Implantation zunehmend an Bedeutung. Die bisher publizierten Ergebnisse zur endovaskulären Therapie der traumatischen Aortenruptur und auch eigene Erfahrungen weisen darauf hin, dass die Einführung der thorakalen Stentgraft-Implantation zu einem Verfahrenswechsel mit der Möglichkeit der frühzeitigen Primärversorgung der lebensbedrohlichen Verletzung ohne zusätzlichen Thoraxeingriff geführt hat. Regelmäßige Kontrolluntersuchungen sind erforderlich, um mögliche Dislokationen der Stentgrafts oder Leckagen zu erkennen und notwendige endovaskuläre oder offen chirurgische Sekundäreingriffe durchführen zu können.

Schlüsselwörter

Traumatische thorakale Aortenruptur Endovaskuläre Therapie Stentgraft 

Traumatic thoracic aorta rupture

Preclinical assessment, diagnosis and treatment options

Abstract

Traumatic aortic rupture is a life-threatening injury which is frequently associated with blunt thoracic trauma or found coincidentally in heavily traumatized patients. Depending on the degree of disruption of the damaged aortic wall, vascular injury is associated with a high primary mortality rate and a significant risk of secondary aortic rupture. Early clinical signs which may indicate a ruptured thoracic aorta are left sided thoracic pain, reduced ventilation, tachycardia and dyspnoe as well as hypotension in the lower extremities. The primary aim for emergency treatment is to maintain vital organ function and to hemodynamically stabilize the patient. Surgical treatment was previously performed by either direct aortic suture or segmental alloplastic graft interposition using the clamp and sew technique with or without extra-anatomic shunts or extracorporeal circulation. However, endovascular stent graft implantation has now become another treatment option for traumatic aortic rupture. According to the reported data and our own experience there is increasing evidence that endovascular aortic repair might become the treatment of choice for patients with traumatic aortic rupture, with the option of an early, less invasive intervention thus avoiding thoracotomy. Regular follow-up is necessary to detect possible stent graft migration or leakage which could require additional endovascular or open surgical re-interventions.

Keywords

Traumatic aortic rupture Endovascular therapy Stent graft 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • R. Kopp
    • 1
  • J. Andrassy
    • 1
  • S. Czerner
    • 2
  • A. Weidenhagen
    • 2
  • R. Weidenhagen
    • 1
  • G. Meimarakis
    • 1
  • M. Reiser
    • 3
  • K.W. Jauch
    • 1
  1. 1.Chirurgische Klinik und PoliklinikKlinikum der LMU München - GroßhadernMünchenDeutschland
  2. 2.Institut für AnästhesiologieKlinikum der LMU München - GroßhadernMünchenDeutschland
  3. 3.Institut für Klinische RadiologieKlinikum der LMU München - GroßhadernMünchenDeutschland

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