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Therapie des abdominalen Aortenaneurysmas

Treatment of abdominal aortic aneurysms

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Zusammenfassung

Die Therapie des abdominalen Aortenaneurysmas (AAA) hat sich durch die Einführung der endovaskulären Stentgraftbehandlung [“endovascular aortic repair“ (EVAR)] entscheidend verändert. In randomisierten Multicenterstudien konnte schlüssig nachgewiesen werden, dass die periprozedurale Komplikations- und Mortalitätsrate nach EVAR im Vergleich zur offenen Behandlung niedriger ist. Allerdings ist nach EVAR mit Folgeproblemen durch Endoleckagen, Migration, Knickbildungen oder Überstentung von Seitenästen bei ungünstiger Morphologie zu rechnen, die eine lebenslange Nachsorge erforderlich machen. Da der größte Teil der therapiebedürftigen Patienten jedoch ein höheres Alter und eine entsprechende Komorbidität aufweist, hat sich bei günstiger Morphologie die endovaskuläre Behandlung durchgesetzt. Eine medikamentöse und konservative Therapie kann bei Patienten mit kleinen bis mittleren Aneurysmen von Bedeutung sein. Rauchen zählt zu den wichtigsten Risikofaktoren für die Entstehung eines AAA. Daher sollten alle Patienten angewiesen werden, das Rauchen zu unterlassen. Die Langzeitbehandlung mit Statinen führte in Studien bei Patienten nach operativem AAA-Ersatz zu einem Rückgang der Gesamt- sowie der kardiovaskulären Mortalität. Entsprechend sollten Patienten mit AAA zur Sekundärprävention Statine erhalten.

Abstract

The treatment of abdominal aortic aneurysms (AAA) has changed significantly since the introduction of endovascular aortic repair (EVAR). In terms of perioperative morbidity and mortality, randomized multicenter trials revealed results in favour of EVAR compared to open reconstruction. However, EVAR is associated with possible late complications caused by endoleaks, stent migration, kinking and/or overstenting of side branches, making life-long follow-up necessary. Since the majority of patients requiring therapy are elderly and exhibit attendant comorbidities, EVAR has become the procedure of choice in those patients with favourable anatomy. Medicamentous and conservative treatment may be relevant in patients with small to medium-sized aneurysms. Since smoking is one of the major risk factors for the development of AAA, all patients should be advised to stop smoking. Studies on long-term statin therapy in patients following surgical AAA repair showed a reduction in both overall and cardiovascular mortality; AAA patients should therefore receive statins for secondary prevention.

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  1. Klinik und Poliklinik für Gefäßmedizin, Gefäßchirurgie - Endovaskuläre Therapie - Angiologie, Deutsches Aortenzentrum Hamburg, Universitäres Herzzentrum GmbH, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    E.S. Debus, S.W. Carpenter, N. Tsilimparis, A. Larena-Avellaneda & T. Kölbel

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  1. E.S. Debus
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  2. S.W. Carpenter
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  3. N. Tsilimparis
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  5. T. Kölbel
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Correspondence to E.S. Debus.

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Debus, E., Carpenter, S., Tsilimparis, N. et al. Therapie des abdominalen Aortenaneurysmas. Internist 54, 543–551 (2013). https://doi.org/10.1007/s00108-012-3218-z

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