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Endovaskuläre Therapie des symptomatischen Aortenulkus

Endovascular therapy of symptomatic aortic ulcer

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Zusammenfassung

Einleitung

Eine Ursache des akuten Aortensyndroms ist das penetrierende artherosklerotische Ulkus (PAU). Aufgrund seiner begrenzten Lokalisation und der hohen Komorbidität bietet sich die endovaskuläre Behandlung als Therapiemöglichkeit an.

Methode

Zwischen Mai 2001 und März 2003 wurden 5 Patienten aufgrund eines symptomatischen PAU mit Stentgraft behandelt. Neben akuten thorakalen Schmerzen bei allen Patienten zeigte sich in der Computertomographie eine kalkdichte Plaque der Aorta (n=5) als „Entry“ des intramuralen Hämatoms (n=5), ein Pleuraerguss (n=3), eine mediastinale Einblutung (n=2) sowie ein Hämatothorax (n=1) zusätzlich.

Ergebnisse

Ein primärer technischer und klinischer Erfolg wurde bei allen 5 Patienten erreicht. Im Nachsorgezeitraum (Mittelwert 15,4 Monate, Spannweite 6–28 Monate) fand sich in allen Fällen eine komplette Ausschaltung des PAU, eine Resorption des Wandhämatoms sowie keine Aufweitung der Aorta im ehemaligen Rupturbereich.

Zusammenfassung

Symptomatische PAU sind potenziell tödliche Läsionen. Ihr Spontanverlauf ist fatal. Betrachtet man die vergleichsweise geringe Morbidität und Mortalität dieser Methode, könnte die endovaskuläre Therapie die Optionen zur Therapie dieser Erkrankung erweitern.

Abstract

Introduction

A cause for acute aortic syndrome is penetrating atherosclerotic ulcer (PAU). Due to its limited localization and its high comorbidity, stent grafting is a promising treatment.

Methods

Between May 2001 and March 2003, five patients with symptomatic PAU were treated with stent grafts. Acute thoracic pain was found in every patient. CT scan showed ruptured sclerotic plaques (n=5) as the “entry” for aortic intramural hematoma (n=5 patients), pleural effusion (n=3), mediastinal bleeding (n=2), and hemothorax (n=1).

Results

Primary technical and clinical success was achieved in all five patients. In the follow-up period (mean: 15.4 months, range: 6–28 months) angio-CT revealed in all cases complete regression of the intramural hematoma, no aortic leak, and no expansion of the aorta at the former site of rupture.

Summary

Symptomatic PAU is a potentially fatal lesion. In relation to asymptomatic PAU or classic dissection, its spontaneous outcome is considerably bad. Looking at the low morbidity and mortality of the method, endovascular stent grafting could expand the scope of options for treating this disease.

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Authors and Affiliations

  1. Universitätsklinik für Thorax- und Gefäßchirurgie, Universität Ulm

    H. Schelzig, K.-H. Orend, L. Sunder-Plassmann & R. Scharrer-Pamler

  2. Universitätsklinik für Radiologie, Universität Ulm

    S. Pauls

  3. Universitätsklinik für Thorax- und Gefäßchirurgie, Universität Ulm, Steinhövelstraße 9, 89075, Ulm

    H. Schelzig

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  1. H. Schelzig
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  2. S. Pauls
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  4. L. Sunder-Plassmann
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Correspondence to H. Schelzig.

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Schelzig, H., Pauls, S., Orend, KH. et al. Endovaskuläre Therapie des symptomatischen Aortenulkus. Gefässchirurgie 9, 201–208 (2004). https://doi.org/10.1007/s00772-004-0345-4

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