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Isolierte Iliakalarterienaneurysmen

Klinischer Hintergrund und interventionelle Versorgungsstrategien

Isolated iliac artery aneurysm

Clinical background and interventional treatment strategies

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Zusammenfassung

Hintergrund

Isolierte Iliakalarterienaneurysmen (IAA) sind bei gleicher, vorwiegend atherosklerotisch-degenerativer Ätiologie seltener als Abdominalaortenaneurysmen (AAA), treten jedoch häufiger als diese mit Symptomen bzw. erst im Stadium der Ruptur in Erscheinung. Betroffen sind vorwiegend Männer über 65 Jahre. Die ideale Bildgebung für Diagnose, Therapieplanung und Nachsorge ist die Computertomographie-Angiographie (CTA). Unter einem Durchmesser von 4 cm liegt das Rupturrisiko bei 6,3 % und steigt anschließend mit zunehmendem Diameter deutlich an. Die Versorgung empfiehlt sich heute frühestens ab einer Größe von 3,5 cm.

Therapie

Aufgrund der geringeren Mortalität ist heute die endovaskuläre Therapie für die elektive und notfällige Versorgung führend. Entscheidend für die Aneurysmaausschaltung ist dabei die Qualität der für die Abdichtung wichtigen Landungszonen. Die Ausschaltung erfolgt mittels Stentgrafts, häufig in Kombination mit Embolisationen. Aufgrund des Risikos für eine Gesäßclaudicatio und eine erektile Dysfunktion empfiehlt sich bei fraglich suffizienter Kollateralisation der Erhalt der ipsilateralen pelvinen Perfusion. Hierfür bieten sich spezielle Seitenarmprothesen oder verschiedene Parallel-Stentgraft-Techniken an.

Nachsorge

Hauptproblem der endovaskulären Versorgung sind Endoleaks und die damit verbundene Notwendigkeit von Reinterventionen. Entscheidend für die rechtzeitige Detektion der Endoleaks ist insbesondere in der Frühphase eine bildgebende Kontrolle mittels CT-Angiographie.

Abstract

Background

Isolated iliac artery aneurysms are less frequent than abdominal aortic aneurysms, with the same, predominantly atherosclerotic-degenerative etiology, but patients present more frequently with symptoms or at the stage of rupture. The majority of those affected are men over the age of 65. The ideal imaging technique for diagnosis, treatment planning and follow-up is computed tomography (CT) angiography. Below a diameter of 4 cm, the risk of rupture is 6.3%, and then increases significantly with increasing diameter. Today, treatment is recommended from a size of 3.5 cm at the earliest.

Therapy

Because of the lower mortality, endovascular therapy is the leading treatment for the elective and emergency situation. The quality of the landing zones, which are important for sealing, is decisive for elimination of the aneurysm. The elimination is carried out by means of stent grafts, often in combination with embolization. Due to the risk of buttock claudication and erectile dysfunction, the preservation of ipsilateral pelvic perfusion is recommended in cases of insufficient collateralization. Special iliac branch devices or various parallel endograft techniques are available for this purpose.

Follow-up

The main problem of endovascular treatment are endoleaks and the associated need for reintervention. Imaging control by means of CT angiography is crucial for timely endoleak detection, especially in the early phase.

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    C. Scheurig-Münkler

  2. Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    S. Zerwes

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Correspondence to C. Scheurig-Münkler.

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C. Scheurig-Münkler und S. Zerwes geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Scheurig-Münkler, C., Zerwes, S. Isolierte Iliakalarterienaneurysmen. Radiologie 62, 607–613 (2022). https://doi.org/10.1007/s00117-022-01002-w

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