Zusammenfassung
Das akute Aortensyndrom (AAS) stellt eine lebensbedrohende Erkrankung dar. Entscheidend ist eine schnelle und genaue Diagnosestellung. Die Patienten sollten unverzüglich schon bei Verdacht auf ein AAS in ein Kompetenzzentrum verlegt werden. Plötzlich einsetzende reißende Brustschmerzen, ein verbreitertes Mediastinum in der Thoraxröntgenaufnahme und Puls-/Blutdruckunterschiede weisen auf eine Aortendissektion hin. Zur Diagnostik ist die Computertomographie Mittel der Wahl, alternativ kann bei hämodynamisch instabilen Patienten der Echokardiographie der Vorzug gegeben werden. Innerhalb der ersten Tage geht das AAS mit einer sehr hohen Mortalität einher. Bei allen Patienten mit AAS sollte daher dringend ein chirurgisches Konsil veranlasst werden. Die anfängliche medikamentöse Therapie zielt auf Schmerzlinderung und Senkung der Aortenwandbelastung ab. Bei einer Aortendissektion unter Beteiligung der Aorta ascendens sollte direkt operiert werden. Ist die Aortendissektion auf die Aorta descendens oder thoracoabdominalis begrenzt, sollte initial medikamentös therapiert werden. Treten jedoch Komplikationen auf, wird eine endovaskuläre Behandlung empfohlen. Ein symptomatisches intramurales Hämatom, ein penetrierendes atherosklerotisches Ulkus oder eine drohende Aortenruptur gehen mit einem erheblichen Risiko einher. Daher gilt hier die Empfehlung einer chirurgischen oder endovaskulären Therapie.
Abstract
Acute aortic syndrome (AAS) is a life-threatening disease. Quick and accurate diagnosis is crucial. Patients should be transferred to a competence center without any delay as soon as AAS is suspected. Immediate onset of tearing chest pain, mediastinal widening on chest radiography and pulse/blood pressure differentials are predictive for aortic dissection. A CT scan is the diagnostic tool of choice; alternatively, in hemodynamically unstable patients echocardiography may be preferred. Associated mortality is excessively high within the first few days. Urgent surgical consultation should be obtained for all patients presenting with AAS. Initial medical therapy is aimed to reduce pain and decrease wall stress in the aorta. Aortic dissection involving the ascending aorta should be treated by immediate surgery. Aortic dissection limited to the descending or thoracoabdominal aorta should be treated medically, initially. However, when associated with complications, endovascular treatment is recommended. A symptomatic intramural hematoma, a penetrating atherosclerotic ulcer or pending aortic rupture are associated with a substantial risk. Therefore, surgical or endovascular therapy is recommended.
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Interessenkonflikt. S. Semsroth, J. Dumfarth, T. Schachner, M. Grimm und H. Domanovits geben an, dass kein Interessenkonflikt besteht.
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Semsroth, S., Dumfarth, J., Schachner, T. et al. Das akute Aortensyndrom. Med Klin Intensivmed Notfmed 109, 371–384 (2014). https://doi.org/10.1007/s00063-014-0391-y
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DOI: https://doi.org/10.1007/s00063-014-0391-y