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Stentversorgung der thorakalen Aorta

Stent graft of the thoracic aorta

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Zusammenfassung

Akute und chronische Aortenerkrankungen gewinnen angesichts der demografischen Entwicklungen und aufgrund der verbesserten Diagnostik zunehmend an Bedeutung. Die operative Therapie stellt weiterhin den Goldstandard in der Behandlung pathologischer Veränderungen im Bereich der Aorta ascendens dar. Durch die Entwicklung endoluminaler Techniken eröffnen sich Alternativen der Behandlung von Erkrankungen der Aorta descendens, des Aortenbogens bei Kombination mit vaskulärem „debranching“, Bypassanlage und Stenting sowie im Einzelfall sogar für die Aorta ascendens. Obwohl in nichtrandomisierten Studien und Metaanalysen sogar eine Überlegenheit im Vergleich zur operativen Therapiestrategie gezeigt werden konnte, sollte bei diesen hochkomplexen Erkrankungen weiterhin eine individuelle Befundbesprechung im Team aus Kardiologen, Herz- und Gefäßchirurgen sowie Spezialisten für Bildgebung stattfinden. Zudem sollte die Therapie Zentren mit ausgewiesener Expertise überlassen werden.

Abstract

Considering the demographic changes in our society and the proliferation of imaging-based improved diagnostics, both acute and chronic aortic diseases attract increasing attention and require dedicated care. Cardiac as well as vascular surgery used to represent the gold standards for therapeutic management of pathologies of the ascending aorta and the arch; however, the technological evolution of endoluminal strategies has had a serious impact on the treatment of the descending aorta, the aortic arch in combination with vascular debranching or bypass, and in selected cases even on managing pathologies of the ascending aorta. Although several case series and meta-analyses of published observations hint towards superiority of endografting in comparison to open surgical repair, the affected usually multimorbid patients with highly complex aortic disease should be subjected to an individual evaluation by a team of cardiologists, cardiac and vascular surgeons as well as imaging specialists; a dedicated individualized treatment concept in highly experienced centers of excellence is likely to provide the best results for such challenging patients.

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  1. Unversitäres Herzzentrum Rostock, Medizinische Klinik I, Universität Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    C.A. Nienaber MD, FESC, FACC, I. Akin, S. Kische, H. Ince & T. Chatterjee

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  1. C.A. Nienaber MD, FESC, FACC
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  2. I. Akin
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  3. S. Kische
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  4. H. Ince
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Correspondence to C.A. Nienaber MD, FESC, FACC.

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Nienaber, C., Akin, I., Kische, S. et al. Stentversorgung der thorakalen Aorta. Internist 54, 561–571 (2013). https://doi.org/10.1007/s00108-012-3219-y

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