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Endovaskuläre Therapie des thorakalen Aortenaneurysmas

Indikationen, Technik und Ergebnisse

Endovascular treatment of thoracic aneurisms

Indications, techniques and results

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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.

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.

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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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Authors and Affiliations

  1. Institut und Poliklinik für Radiologische Diagnostik, Universitätsklinikum Carl-Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    T. Hofmockel, V. Plodeck, M. Laniado &  R.-T. Hoffmann

  2. Klinik für Viszeral-, Thorax-, Gefäßchirurgie, Universitätsklinikum Dresden, Dresden, Deutschland

    R. Grützmann

  3. Universitäts GefäßCentrum und Medizinische Klinik III – Bereich Angiologie, Universitätsklinikum Dresden, Dresden, Deutschland

    N. Weiss

Authors
  1. T. Hofmockel
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  2. V. Plodeck
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  3. R. Grützmann
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  4. N. Weiss
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  5. M. Laniado
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  6. R.-T. Hoffmann
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Corresponding author

Correspondence to R.-T. Hoffmann.

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Hofmockel, T., Plodeck, V., Grützmann, R. et al. Endovaskuläre Therapie des thorakalen Aortenaneurysmas. Radiologe 53, 513–518 (2013). https://doi.org/10.1007/s00117-012-2452-7

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