Endovaskuläre Therapie des thorakalen Aortenaneurysmas
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Zusammenfassung
Klinisches Problem Thorakales Aortenaneurysma
Das Aneurysma ist eine der häufigsten Erkrankung der thorakalen Aorta mit stetig wachsender Inzidenz. Die Hauptursache ist die Arteriosklerose. Es stellt im klinischen Alltag eine besondere Anforderung dar, wegen der überwiegenden Symptomfreiheit bzw. -armut und den möglichen letalen Komplikationen wie der Aortenruptur.
Radiologische Standardverfahren
Die CT-Angiographie stellt den Goldstandard in der Bildgebung dar. Auch die MR-Angiographie wird zunehmend als bildgebendes Verfahren genutzt, wenn auch in der Nachsorge und nicht in der akuten Versorgung des TAA.
Behandlungsindikation
Eine zwingende Behandlungsindikation besteht bei einem Durchmesser von 5 bis 5,5 cm für die aszendierende und 6,5 cm für die deszendierende Aorta.
Thoracic endovascular aortic repair
Mit der stetigen Weiterentwicklung der aortalen Stentgrafts seit Parodi, Palmaz und Dake ist die TEVAR zu einem etablierten Verfahren geworden, das in den letzten Jahren einen sprunghaften Anstieg erfährt.
Empfehlung für die Praxis
TEVAR ist zum offen-chirurgischen Verfahren eine schonende Alternative, insbesondere bei den häufig multimorbiden älteren Patienten.
Schlüsselwörter
Aorta Thorakales aortenaneurysma Thoracic endovascular aortic repair TEVAR StentgraftEndovascular treatment of thoracic aneurisms
Abstract
Clinical issue of thoracic aneurysms
Aneurysms are among the most common diseases affecting the thoracic aorta, with a continuous increase in incidence over the recent decades. The main cause of thoracic aneurysms is atherosclerosis, which, due to the frequent lack of major symptoms and the potentially lethal complications such as ruptured aortic aneurysm, remains a challenge in clinical practice.
Standard radiological methods
CT angiography remains the imaging method of choice for acute aortic aneurysms, with MR angiography being increasingly used for follow-up imaging.
Threshold for treatment
In the ascending aorta a diameter larger than 5–5.5 cm (descending aorta 6.5 cm) is regarded as the threshold for treatment.
Thoracic endovascular aortic repair
The continuous evolution of aortic stent grafting (i.e., thoracic endovascular aortic repair [TEVAR]) since Parodi, Palmaz and Dake has led to a steep rise in stent grafting procedures in recent years.
Practical recommendations
Particularly in elderly patients with multiple comorbidities, TEVAR is a valuable, less invasive option compared to open surgical repair.
Keywords
Aorta Aortic aneurysm Thoracic endovascular aortic repair TEVAR Stent graftNotes
Interessenskonflikte
Bei H.T., P.V., G.R., W.N. bestehen keine Interessenskonflikte. Prof. Dr. RT Hoffmann ist gelegentlich als Proctor der Fa. Gore tätig.
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