Zusammenfassung
Klinisches Problem
Isolierte Aneurysmen der iliakalen Arterien sind wesentlich seltener als infrarenale Aortenaneurysmen und treten ebenfalls vorwiegend bei älteren männlichen Patienten auf. Sie sind meist asymptomatisch und werden zufällig radiologisch diagnostiziert. Ab einem maximalen Querdurchmesser von 3 cm steigt das Risiko einer potenziell fatalen Ruptur
Therapeutische Standardverfahren
Zur Prävention der Ruptur wie auch in der Behandlung des rupturierten Iliakalarterienaneurysmas hat sich die endovaskuläre Technik mittels Stentgrafts und, je nach Anatomie, kombiniert mit einer Embolisation von A.-iliaca-interna-Ästen als primäre Methode etabliert. Diese Wahl ist bei im Vergleich mit der offen-chirurgischen Therapie geringerer Morbidität und Mortalität gerechtfertigt.
Neue Therapieverfahren
Langfristig benötigen bis zu einem Viertel der Patienten nach einer endovaskulären iliakalen Aneurysmaausschaltung perkutane Reinterventionen. Unter der Prämisse einer zuverlässigen Nachkontrolle lassen sich Rupturen nach endovaskulärer Therapie sicher vermeiden.
Abstract
Clinical issue
Isolated iliac artery aneurysms occur considerably less often than abdominal aortic aneurysms. Mainly older men are affected by this disease. Most of these aneurysms are asymptomatic and are incidentally detected during cross-sectional imaging. Iliac aneurysms with a diameter larger than 3 cm are at risk for rupture, which is associated with high morbidity and mortality.
Standard treatment
To prevent their rupture as well as for symptomatic or ruptured aneurysms, endovascular treatment has recently been established as the primary approach due to the decreased morbidity and mortality compared to open repair. Endovascular aneurysm exclusion is performed with stent grafts, and depending on the anatomy, by adjunctive internal iliac artery embolization.
Treatment innovations
Up to a quarter of treated patients will require additional endovascular revisions during the long term. Reliable imaging follow-up likely increases the safety of elective or emergent endovascular iliac artery aneurysm repair.
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T. Pfammatter, A. Kobe und M. L. Lachat geben an, dass kein Interessenkonflikt besteht.
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Pfammatter, T., Kobe, A. & Lachat, M.L. Isolierte Aneurysmen der Iliakalarterien. Radiologe 58, 837–840 (2018). https://doi.org/10.1007/s00117-018-0434-0
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DOI: https://doi.org/10.1007/s00117-018-0434-0