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Chronische Aortendissektion Typ B – was tun?

Chronic type B aortic dissection—what to do?

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Zusammenfassung

Hintergrund

Die chronische Aortendissektion Typ B wird mit einer optimalen medikamentösen Therapie behandelt. Dennoch zwingen sekundäre Komplikationen wie eine Organ- oder Extremitätenischämie oder die Ausbildung eines progredienten Aneurysmas zur interventionellen Therapie.

Fragestellung

Darstellung verschiedener endovaskulärer Behandlungsoptionen der chronischen Typ-B-Aortendissektion.

Material und Methode

Aktuelle Literaturanalyse zu Indikation, Technik, Ergebnissen und Differenzialindikation der interventionellen Techniken zur Behandlung von Komplikationen der chronischen Typ-B-Aortendissektion.

Ergebnisse

Die endovaskuläre Implantation eines Aortenstentgrafts stellt die interventionelle Standardtherapie zur Behandlung der aneurysmatischen Dilatation der Aorta nach Typ-B-Dissektion dar. Technische Probleme sind die korrekte Wahl der proximalen und distalen Landungszone und die Versorgung eines persistierenden Flusses im falschen Lumen.

Schlussfolgerung

Die endovaskuläre Therapie der chronischen komplizierten Typ-B-Dissektion gewinnt gegenüber der offenen chirurgischen Behandlung immer mehr an Bedeutung, weil neben der Stentgraft-Implantation mit komplexen Prothesentypen (fenestrierte und mit Seitarmen versehene Implantate) auch neue effektive endovaskuläre Techniken zur Okklusion des falschen Lumens (z. B. „candy plug“) entwickelt wurden.

Abstract

Background

Chronic type B aortic dissection requires optimal medical therapy. However, secondary complications like organ or extremity malperfusion or development of aneurysmal dilatation require interventional therapy.

Objectives

Presentation of different endovascular treatment options for complications of chronic type B aortic dissection.

Materials and methods

Analysis of current literature with regard to indications, techniques, results, and differential indications of interventional techniques for the treatment of chronic type B aortic dissection complications.

Results

Endovascular implantation of an aortic stent graft is interventional standard therapy for treatment of aneurysmal dilatation of the aorta following type B dissection. Technical problems are the proximal and distal landing zones and the treatment of persistent flow in the false lumen.

Conclusion

Endovascular treatment of chronic complicated type B aortic dissection is increasingly used compared to open surgical treatment because not only are more complex stent grafts (fenestrated and branched devices) available but also because of newly developed techniques for effective occlusion of flow in the false lumen (e.g., candy plug).

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Authors and Affiliations

  1. Institut für Radiologie und Interventionelle Therapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland

    Michael Burbelko &  Hans-Joachim Wagner

  2. Klinik für Diagnostische und Interventionelle Radiologie, UKGM Marburg, Philipps-Universität Marburg, Marburg, Deutschland

    Andreas H. Mahnken

Authors
  1. Michael Burbelko
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  2. Hans-Joachim Wagner
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  3. Andreas H. Mahnken
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Correspondence to Hans-Joachim Wagner.

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Interessenkonflikt

M. Burbelko, H.-J. Wagner und A.H. Mahnken 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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Burbelko, M., Wagner, HJ. & Mahnken, A.H. Chronische Aortendissektion Typ B – was tun?. Radiologie 62, 556–562 (2022). https://doi.org/10.1007/s00117-022-01022-6

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