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Poplitealaneurysma

Popliteal aneurysm

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Zusammenfassung

Das Poplitealaneurisma (PA) ist eine typische Erkrankung von Männern über 65 Jahren, bei denen häufig Aneurysmen der Aorta, der iliacalen, femoralen und kontralateralen Poplitealarterie vorkommen. Als Ursache des Poplitealaneurysmas (PA) werden prioritär die Degradation durch Matrixmetalloproteinasen, eine entzündliche Reaktion mit Bildung von reaktiven Sauerstoffradikalen sowie der oxidative Stress in der Arterienwand postuliert. Zwei Drittel der Patienten kommen wegen Symptomen zum Chirurgen, die übrigen wegen eines Zufallsbefundes oder weil bereits die Gegenseite operiert wurde. Die akute und chronische Ischämie mit ihrer hohen Morbidität stehen im Vordergrund. Asymptomatische PA sollten ab einem Durchmesser von 2 cm therapeutisch angegangen werden, besonders wenn sie partiell thrombosiert sind. Zur Diagnostik reicht eine Duplexuntersuchung. Die digitale Subtraktionsangiographie ist die wichtigste Untersuchung für die Operationsplanung. Lokalisierte Befunde, die auf die Kniekehle begrenzt sind, können von dorsal, langstreckige PA müssen durch einen Zugang von medial mit einem Interponat überbrückt werden. Dabei ist eine autologe Vene dem Kunststoffinterponat vorzuziehen. Im Fall eines Veneninterponates oder -bypasses kann mit einer Offenheitsrate von 85% nach 5 Jahren gerechnet werden. Endografts sollen nur ausnahmsweise oder im Rahmen von Studien eingesetzt werden.

Abstract

Aneurisms of the popliteal arteries are rare and mainly seen in men older than 65 years of age. They may appear bilateral. Aortoiliac or femoral aneurysms are also common in this group of patients. Matrix metalloproteinase activity, inflammation, formation of free radicals in the arterial wall, and oxidative stress have been connected with the development of aneurysms. Two/thirds of the patients are seen due to acute or chronic limb ischemia, which exhibit a high rate of morbidity. Asymptomatic popliteal aneurysms with a diameter of 2 cm or more should be considered for treatment, especially when they are partially thrombosed. A duplex examination is used for diagnostic work-up. Digital subtraction angiography is the cornerstone of operative planning. Localized aneurysms in the knee region can be approached posteriorly; medial access is preferred especially for larger aneurysms. Saphenous vein grafts are preferable over prosthetic grafts. A patency rate of 85% after 5 years can be expected with vein grafts. Endografts should only be used in highly selected cases or in a clinical trial setting.

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  1. Klinik für Herz-und Gefässchirurgie, Inselspital, 3010 , Bern, Schweiz

    M. K. Widmer, J. Schmidli & T. Carrel

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  1. M. K. Widmer
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  2. J. Schmidli
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  3. T. Carrel
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Correspondence to M. K. Widmer.

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Widmer, M.K., Schmidli, J. & Carrel, T. Poplitealaneurysma. Gefässchirurgie 11, 299–311 (2006). https://doi.org/10.1007/s00772-006-0474-z

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  • DOI: https://doi.org/10.1007/s00772-006-0474-z

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