Skip to main content

Advertisement

SpringerLink
Log in

Hybridverfahren zur stentgestützten Ausschaltung eines thorakoabdominalen Aortenaneurysmas

Hybrid procedures for stent-assisted treatment of thoracoabdominal aortic aneurysms

  • Operative Techniken
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Ausschaltung eines thorakoabdominalen Aortenaneurysmas (TAAA) kann heutzutage offen, ggf. unter Einsatz der Herz-Lungen-Maschine, mittels Endoprothesen mit Seitenarmen („branched grafts“) oder kombiniert offen und endovaskulär als sog. Hybrid-Op. erfolgen. Bei dieser Technik wird in einem ersten Schritt ein sog. „abdominelles Debranching“ d. h. offene Revaskularisation der Nieren- und Viszeralgefäße durchgeführt. Im zweiten Schritt erfolgt die stentgestützte Ausschaltung des Aneurysmas. Bei dieser Technik entfällt das hohe aortale Cross-clamping, das für Paraplegie und Nierenversagen mit verantwortlich gemacht wird. Gegenüber den „branched grafts“ besteht der Vorteil, dass keine Seitarme, die evtl. aus der Hauptprothese dislozieren können, benötigt werden. Das hier vorgestellte Konzept ist somit eine alternative Variante in der TAAA-Behandlung – v. a. bei Patienten, die für einen 2-Höhlen-Eingriff nicht geeignet sind.

Abstract

Repair of a thoracoabdominal aortic aneurysm (TAAA) can nowadays be carried out with open surgery, if necessary using a heart-lung machine, using branched grafts or combined open and endovascular procedures as a so-called hybrid operation. This technique involves an initial step of so-called abdominal debranching, i.e. open revascularization of renal and visceral vessels. The second step involves stent-assisted repair of the aneurysm. This technique avoids high aortic cross-clamping which may be responsible for paraplegia and renal failure. In contrast to branched grafts it has the advantage that side branches which can possibly become detached from the main stent are unnecessary. The concept presented in this article represents an alternative treatment for TAAA, in particular for patients unfit for open repair involving two body cavities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Black SA, Wolfe JH, Clark M et al (2006) Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 43(6):1081–1089 (discussion 1089)

    Article  PubMed  Google Scholar 

  2. Böckler D, Kotelis D, Geisbüsch P et al (2008) Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections—a single center experience in 28 patients. J Vasc Surg 47(4):724–732

    Article  PubMed  Google Scholar 

  3. Chiesa R, Tshomba Y, Melissano G et al (2007) Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery. J Vasc Surg 45(6):1128–1135

    Article  PubMed  Google Scholar 

  4. Coselli JS, Conklin LD, LeMaire SA (2002) Thoracoabdominal aortic aneurysm repair: review and update of current strategies. Ann Thorac Surg 74(5):1881–1884 (discussion 1892–1898)

    Article  Google Scholar 

  5. Cox GS, O’Hara PJ, Hertzer NR et al (1992) Thoracoabdominal aneurysm repair: a representative experience. J Vasc Surg 15(5):780–787 (discussion 787–788)

    Article  PubMed  CAS  Google Scholar 

  6. Derrow AE, Seeger JM, Dame DA et al (2001)The outcome in the United States after thoracoabdominal aortic aneurysm repair, renal artery bypass, and mesenteric revascularization. J Vasc Surg 34(1):54–61

    Article  PubMed  CAS  Google Scholar 

  7. Donas KP, Czerny M, Guber I et al (2007) Hybrid open-endovascular repair for thoracoabdominal aortic aneurysms: current status and level of evidence. Eur J Vasc Endovasc Surg 34(5):528–533 [Epub 2007 Aug 1. Review]

    Article  PubMed  CAS  Google Scholar 

  8. Fulton JJ, Farber MA, Marston WA et al (2005) Endovascular stent-graft repair of pararenal and type IV thoracoabdominal aortic aneurysms with adjunctive visceral reconstruction. J Vasc Surg 41(2):191–198 (Erratum in: J Vasc Surg 41(5):906)

    Google Scholar 

  9. Kotsis T, Scharrer-Pamler R, Kapfer X et al (2003) Treatment of thoracoabdominal aortic aneurysms with a combined endovascular and surgical approach. Int Angiol 22(2):125–133

    PubMed  CAS  Google Scholar 

  10. Lundbom J, Hatlinghus S, Odegård A et al (2004) Combined open and endovascular treatment of complex aortic disease. Vascular 12(2):93–98

    Article  PubMed  Google Scholar 

  11. Quiñones-Baldrich WJ, Panetta TF, Vescera CL, Kashyap VS (1999) Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach. J Vasc Surg 30(3):555–60

    Article  PubMed  Google Scholar 

  12. Rimmer J, Wolfe JH (2003) Type III thoracoabdominal aortic aneurysm repair: a combined surgical and endovascular approach. Eur J Vasc Endovasc Surg 26(6):677–679

    Article  PubMed  CAS  Google Scholar 

  13. Safi HJ, Campbell MP, Miller CC 3rd et al (1997) Cerebral spinal fluid drainage and distal aortic perfusion decrease the incidence of neurological deficit: the results of 343 descending and thoracoabdominal aortic aneurysm repairs. Eur J Vasc Endovasc Surg 14(2):118–124

    Article  PubMed  CAS  Google Scholar 

  14. Svensson LG, Crawford ES, Hess KR et al (1993) Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17(2):357–368 (discussion 368–370)

    Article  PubMed  CAS  Google Scholar 

  15. Tse LW, MacKenzie KS, Montreuil B et al (2004) The proximal landing zone in endovascular repair of the thoracic aorta. Ann Vasc Surg 18(2):178–185

    Article  PubMed  Google Scholar 

  16. Zhou W, Reardon M, Peden EK et al (2006) Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes. J Vasc Surg 44(4):688–693 [Epub 2006 Aug 22]

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung(en) hin: Bernd Mühling und Karl-Heinz Orend sind regelmäßig Referenten für die Fa. Medtronic.

Author information

Authors and Affiliations

  1. Sektion Gefäßchirurgie, Klinik für Herz-, Thorax- und Gefäßchirurgie, Zentrum für Chirurgie, Universität Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    K.-H. Orend &  B. Mühling

Authors
  1. K.-H. Orend
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Mühling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Mühling.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Orend, KH., Mühling, B. Hybridverfahren zur stentgestützten Ausschaltung eines thorakoabdominalen Aortenaneurysmas. Z Herz- Thorax- Gefäßchir 26, 222–228 (2012). https://doi.org/10.1007/s00398-012-0934-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-012-0934-6

Schlüsselwörter

Keywords

Search

Navigation