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Aneurysmen der thorakoabdominalen Aorta – endovaskuläre Therapieoptionen

Thoracoabominal aortic aneurysms—endovascular options

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Zusammenfassung

Hintergrund

Thorakoabdominelle Aortenaneurysmen (TAAA) sind vorwiegend arteriosklerotisch bedingt und verlaufen meist symptomlos. Therapiebedürftig sind diese ab einer Größe von 6,5 cm. Bei raschem Größenwachstum, Kompression von Organstrukturen sowie durch Bindegewebserkrankungen entstehende Aneurysmen besteht bereits ab einer Größe von 6 cm die Notwendigkeit einer Behandlung.

Methode

Für elektive Eingriffe stehen die Möglichkeiten der Versorgung mittels fenestrierter und/oder gebranchter Prothesen zur Verfügung. Auch gibt es die Chimney‑, Sandwich- oder Periskoptechniken für die Versorgung der TAAA. Je nach Ausdehnung sind noch Verlängerungen mittels tubulärer Prothesen thorakal oder Bifurkationsprothesen abdominal notwendig. Die Eingriffe erfolgen entweder über chirurgisch freigelegte Zugänge, rein perkutan oder kombiniert. Bei symptomatischen TAAA besteht die Möglichkeit der Implantation eines t‑Branch® oder die Behandlung mittels Chimney‑, Sandwich- und Periskoptechnik.

Schlussfolgerung

Die endovaskuläre Versorgung von TAAA stellt in der präinterventionellen Abklärung mittels Computertomographie (CT) sowie der daraus folgenden Planung und Vermessung eine große Herausforderung dar, und auch der Eingriff selbst erfordert ein gut eingespieltes interdisziplinäres ärztliches und nichtärztliches Team.

Abstract

Background

Thoracoabdominal aortic aneurysms (TAAA) are predominantly atherosclerotic related and are usually asymptomatic. Treatment is necessary from a size greater 6.5 cm, while patients with rapidly growing, compression of organ structures, aneurysm-related connecting tissue orders must be treated from a diameter of 6 cm.

Methods

Elective interventions may be performed with fenestrated and/or branched grafts. Another possibility is the chimney, sandwich or periscop technique for treating TAAA. Depending on the extension of the TAAA, implantation of tube grafts for the thoracic aorta or bifurcation grafts for the abdominal aorta is necessary. Symptomatic TAAA may be treated by implantation of a t-Branch® or using the chimney, sandwich or periscop technique.

Conclusions

The preinterventional planning and sizing with the help of computed tomography (CT) scans for endovascular repair of TAAA, and the implantation of the grafts during the procedure are challenging; thus, a well-experienced interdisciplinary team of medical and nonmedical specialists is required.

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Authors and Affiliations

  1. Institut für diagnostische und interventionelle Radiologie, Ordensklinikum Linz, Fadingerstraße 1, 4020, Linz, Österreich

    M. Gschwendtner EBIR

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  1. M. Gschwendtner EBIR
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Correspondence to M. Gschwendtner EBIR.

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Interessenkonflikt

M. Gschwendtner hat Proctorverträge mit Cook, Vascutec, Medtronic, Cardinal Health.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gschwendtner, M. Aneurysmen der thorakoabdominalen Aorta – endovaskuläre Therapieoptionen. Radiologe 58, 814–821 (2018). https://doi.org/10.1007/s00117-018-0433-1

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  • DOI: https://doi.org/10.1007/s00117-018-0433-1

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