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Stumpfe traumatische Aortenverletzung

Stellenwert der transösophagealen Echokardiographie

Blunt traumatic aortic injury

Importance of transesophageal echocardiography

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Zusammenfassung

Die traumatische Aortenverletzung kann eine deletäre Komplikation des stumpfen Thoraxtraumas sein. Wenn sie überlebt und diagnostiziert wird, ist eine chirurgische Versorgung notwendig. Voraussetzung ist eine zeitnahe bildgebende Diagnostik dieser Verletzung, um je nach Verletzungsschwere ein für den Patienten optimales therapeutisches Vorgehen planen zu können. Die digitale Angiographie wurde mittlerweile von nichtinvasiven Methoden wie der Computertomographie (CT) oder der transösophagealen Echokardiographie (TEE) abgelöst. Mithilfe der TEE ist es möglich, eine Stadieneinteilung dieser Verletzungen durchzuführen. Mit dieser Klassifikation und der dazugehörigen klinischen Symptomatik ergibt sich das therapeutische Handlungsschema. In vielen Fällen ist heute eine Versorgung im Intervall üblich. Neben einer adäquaten Blutdruckeinstellung (zur Prophylaxe der freien Ruptur) sind ggf. Untersuchungen im Verlauf erforderlich. Hier liegt ein großer Vorteil der TEE in der Untersuchung des meistens polytraumatisierten Patienten am Krankenbett. Diese Übersicht beschreibt den Einsatz der TEE als ein diagnostisches Instrument in der frühen Phase und als Mittel der Verlaufsuntersuchungen bei einem primär konservativen Regime.

Abstract

Traumatic injury of the aorta can be a fatal complication of blunt thoracic trauma and if it is survived and diagnosed, surgery will be necessary. A prerequisite is a prompt imaging diagnosis of the injury in order to plan an optimal therapeutic procedure for the patient, depending on the severity of the injury. Digital angiography has now been replaced by non-invasive methods, such as computer tomography (CT) or transesophageal echocardiography (TEE). Using TEE it is possible to carry out a staging of the injury and this classification together with the corresponding clinical symptoms determines the therapeutic treatment regime. In many cases a staged treatment is standard procedure. In addition to the establishment of an adequate blood pressure (for prophylaxis of the open rupture), monitoring during the course of treatment may be necessary. The main advantage of TEE is that the examination of these mostly multiple traumatised patients can be carried out at the bedside. This review describes the use of TEE as a diagnostic tool in the early phase and for continuous monitoring of an initially conservative treatment regime.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    C. Hainer, M. Bernhard, K. Scheuren, H. Rauch, E. Martin & M.A. Weigand

  2. Klinik für Gefäßchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    D. Böckler

  3. Institut für Rechts- und Verkehrsmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    K.M. Stein

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  1. C. Hainer
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  2. D. Böckler
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  3. M. Bernhard
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  4. K. Scheuren
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  5. K.M. Stein
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  6. H. Rauch
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  7. E. Martin
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  8. M.A. Weigand
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Correspondence to C. Hainer.

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Hainer, C., Böckler, D., Bernhard, M. et al. Stumpfe traumatische Aortenverletzung. Anaesthesist 57, 262–268 (2008). https://doi.org/10.1007/s00101-008-1334-x

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  • DOI: https://doi.org/10.1007/s00101-008-1334-x

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