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Endovaskuläre Therapie bei aneurysmatischer Allograftdegeneration

Endovascular therapy of aneurysmal allograft degeneration

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Zusammenfassung

Protheseninfektionen sind seltene, aber lebensbedrohende Komplikationen in der aortalen Gefäßchirurgie. Nach der Prothesenentfernung kann die orthotope Revaskularisation mit Hilfe von allogenen Gefäßtransplantaten erfolgen, womit inzwischen gute Behandlungsergebnisse erzielt wurden. Eine bekannte Spätfolge ist die immunologisch vermittelte Graftdegeneration mit resultierender Aneurysmabildung.

Wir berichten über einen Patienten, der bei aortobifemoraler Protheseninfektion eine In-situ-Rekonstruktion mit Hilfe eines kryokonservierten Allografts erhalten hatte. Nach einem infektfreien Intervall von 27 Monaten nach der Allograftimplantation entwickelte er eine bilaterale iliakofemorale Aneurysmose, die durch eine das Leistenband überbrückende endovaskuläre Aneurysmaausschaltung mit Hilfe einer „home-made“ Stentprothese (ePTFE und Palmaz®-Stent) erfolgreich behandelt wurde. Im Follow-up von 12 Monaten zeigte sich ein regelgerechter Verlauf.

Wenn sich die guten Ergebnisse im Langzeitverlauf bestätigen, könnte das endovaskuläre Vorgehen bei der degenerativen Allograftaneurysmose zu einer therapeutischen Option werden und eine potenziell risikoreiche Reoperation bei Allograftdegeneration verhindern.

Abstract

Graft infections following aortic vascular procedures are rare, but they are life threatening. Orthotopic vascular restoration with allogenic grafts is a therapeutic option following removal of the infected material. However, graft degeneration is a well-known drawback during follow-up.

We present a case of prosthetic infection (bifurcated graft) managed by orthotopic reconstruction with cryopreserved allografts. During follow-up of 27 months without infection, aneurysmal degeneration of the iliac femoral part of the allograft developed. Bilateral endovascular aneurysm exclusion was performed by a homemade device (ePTFE and Palmaz® stent).

According to the results of follow-up, the endovascular approach might become the therapy of choice in cases of aortic allograft degeneration.

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  1. Schwerpunkt Gefäßchirurgie, Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Klinikum der Universität zu Köln

    M. Gawenda, M. Aleksic & J. Brunkwall

  2. Institut für Radiologische Diagnostik, Klinikum der Universität zu Köln

    M. Zähringer

  3. Schwerpunkt Gefäßchirurgie, Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50931, Köln

    M. Gawenda

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  1. M. Gawenda
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  2. M. Aleksic
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  3. M. Zähringer
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  4. J. Brunkwall
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Correspondence to M. Gawenda.

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Gawenda, M., Aleksic, M., Zähringer, M. et al. Endovaskuläre Therapie bei aneurysmatischer Allograftdegeneration. Gefässchirurgie 9, 122–126 (2004). https://doi.org/10.1007/s00772-004-0338-3

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