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Konversionsoperationen nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen

Conversion to open surgery after endovascular treatment of abdominal aortic aneuryms

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Zusammenfassung

Konversionsoperationen sind Folge einer insuffizienten endovaskulären Ausschaltung infrarenaler Aortenaneurysmen. Eine Indikation zu Konversionsoperation kann sich aus dem Vorliegen von Endoleckagen, dem Auftreten von Prothesenverschlüssen oder aus einem Aneurysmawachstum ergeben. In der eigenen Klinik wurden in einem Zeitraum von 9,5 Jahren 235 endovaskuläre Aneurysmaausschaltungen vorgenommen. Es wurden insgesamt 19 Konversionseingriffe, 5 primäre Sofortkonversionen und 14 Spätkonversionen (>30 Tage) erforderlich. Das entspricht einer Konversionsrate von 8,1%.

Die Sofortkonversionen zeigten eine hohe Mortalitätsrate von 20,0%, die elektiven Spätkonversionen eine Mortalitätsrate von 7,7%. Im Stadium der Ruptur liegt die Mortalitätsrate um ein vielfaches höher. Konversionseingriffe sind technisch anspruchsvoll und sollten daher unter Elektivbedingungen erfolgen. Dies setzt eine sorgfältige Verlaufskontrolle voraus. Das Risiko der Konversionsoperation muss in die differenzialtherapeutischen Überlegungen vor jeder endovaskulären Aneurysmaausschaltung mit einbezogen werden. Durch eine stringente Indikationsstellung und technisch verbesserte Endoprothesen lässt sich das Risiko einer Konversionsoperation reduzieren.

Abstract

Insufficient endografting of infrarenal aortic aneurysms can lead to conversion. Indications for conversion can be the incidence of endoleakage, occlusion of the endograft or progressive aneurysm growth. Over a period of 9.5 years, 235 patients underwent endovascular treatment of infrarenal aortic aneurysms at our clinic. Altogether, 19 conversion procedures were necessary, five of which were primary immediate conversions, while 14 were performed at a later time (>30 days). This corresponds to a conversion rate of 8.1%.

Patients treated with primary conversion demonstrated a high mortality rate of 20.0%, whereas the elective secondary conversions showed a lethal outcome in 7.7% of cases. At rupture, the mortality rate is significantly higher. Conversion procedures demand a high standard of technical skill and, therefore, should be performed under elective conditions. Careful follow-up after endovascular aortic aneurysm repair is required. The risk of conversion has to be kept in mind when planning endovascular procedures. Specific selection of patients and technical improvement of the endografts reduce the risk.

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  1. Evangelisches Krankenhaus Mülheim an der Ruhr, Gefäßchirurgische Klinik, Wertgasse 30, 45468, Mülheim an der Ruhr

    M. Heidrich & K. Balzer

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  1. M. Heidrich
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  2. K. Balzer
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Correspondence to M. Heidrich.

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Heidrich, M., Balzer, K. Konversionsoperationen nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen. Gefässchirurgie 11, 253–260 (2006). https://doi.org/10.1007/s00772-006-0477-9

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  • DOI: https://doi.org/10.1007/s00772-006-0477-9

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