Skip to main content
SpringerLink
Log in

Thorakoabdominelle Aortenaneurysmen

Thoracoabdominal aortic aneurysms

  • Klinischer Review
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Die Ausschaltung von thorakoabdominellen Aortenaneurysmen (TAAA) ist auch heute noch die größte Herausforderung für Gefäßchirurgen. Für viele Jahrzehnte stellte das offen-chirurgische Verfahren die einzige Behandlungsoption dar. Durch eine kontinuierliche Verbesserung der Operationstechnik und durch Einführung perioperativer Maßnahmen zur Organprotektion können heutzutage in hoch spezialisierten Zentren sehr gute Ergebnisse erzielt werden. Mit dem Ziel, die Invasivität dieser Eingriffe zu reduzieren, haben sich in den letzten Jahren zunehmend auch Hybridoperationen etabliert, bei denen ein viszerorenales Debranching mit einer endovaskukären Aneurysmaausschaltung kombiniert wird. Auch eine total endovaskuläre Ausschaltung von TAAAs mit gebranchten und fenestrierten Spezialprothesen ist heutzutage möglich und wird weltweit in zunehmendem Maß durchgeführt. Welches der genannten Operationsverfahren mit dem besten Resultat assoziiert ist, bleibt bis heute jedoch unklar, da keine Daten aus prospektiv-randomisierten Studien vorliegen. In diesem klinischen Review werden die aktuellsten Ergebnisse zu den unterschiedlichen Therapieverfahren vorgestellt und bewertet.

Abstract

The surgical management of patients with thoracoabdominal aortic aneurysms (TAAA) is very challenging even today. For many decades open surgical TAAA repair was the only treatment option for these patients. As a result of a continuous evolution of the surgical procedure, which includes the introduction of adjunctive procedures for organ protection, open TAAA repair can nowadays be performed with excellent results in specialized centers. However, in order to reduce the invasiveness of the surgical procedure, hybrid or total endovascular operations have increasingly become available in recent years and retrospective trials have also shown acceptable morbidity and mortality rates. As yet no randomized trials exists which compare the various surgical procedures. This article reviews recent publications of open surgical, endovascular and hybrid TAAA repair techniques which can provide a basis for clinical decision-making.

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

Literatur

  1. Bakoyiannis C, Kalles V, Economopoulos K et al (2009) Hybrid procedures in the treatment of thoracoabdominal aortic aneurysms: a systematic review. J Endovasc Ther 16:443–450

    Article  PubMed  Google Scholar 

  2. Coselli JS, LeMaire SA, Miller CC III et al (2000) Mortality and paraplegia after thoracoabdominal aortic aneurysm repair: a risk factor analysis. Ann Thorac Surg 69:409–414

    Article  CAS  PubMed  Google Scholar 

  3. Coselli JS, Bozinovski J, LeMaire SA (2007) Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg 83:S862–S864

    Article  PubMed  Google Scholar 

  4. Cowan JA Jr, Dimick JB, Henke PK et al (2003) Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes. J Vasc Surg 37:1169–1174

    Article  PubMed  Google Scholar 

  5. Crawford ES, Coselli JS (1991) Thoracoabdominal aneurysm surgery. Semin Thorac Cardiovasc Surg 3:300–322

    CAS  PubMed  Google Scholar 

  6. Davies RR, Goldstein LJ, Coady MA et al (2002) Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 73:17–27

    Article  PubMed  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 34:528–533

    Article  CAS  PubMed  Google Scholar 

  8. Donas KP, Lachat M, Rancic Z et al (2009) Early and midterm outcome of a novel technique to simplify the hybrid procedures in the treatment of thoracoabdominal and pararenal aortic aneurysms. J Vasc Surg 50:1280–1284

    Article  PubMed  Google Scholar 

  9. Drinkwater SL, Bockler D, Eckstein H et al (2009) The visceral hybrid repair of thoraco-abdominal aortic aneurysms–a collaborative approach. Eur J Vasc Endovasc Surg 38:578–585

    Article  CAS  PubMed  Google Scholar 

  10. Greenberg RK, Lu Q, Roselli EE et al (2008) Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation 118:808–817

    Article  PubMed  Google Scholar 

  11. Haulon S, D’Elia P, O’Brien N et al (2010) Endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg 39:171–178

    Article  CAS  PubMed  Google Scholar 

  12. Jacobs MJ, Mess W, Mochtar B et al (2006) The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair. J Vasc Surg 43:239–246

    Article  PubMed  Google Scholar 

  13. Jacobs MJ, Mommertz G, Koeppel TA et al (2007) Surgical repair of thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino) 48:49–58

    Google Scholar 

  14. Koeppel TA, Langer S, Debus ES et al (2010) Thoracic aortic aneurysms. Gefässchirurgie 15:468–476

    Article  Google Scholar 

  15. LeMaire SA, Carter SA, Volguina IV et al (2006) Spectrum of aortic operations in 300 patients with confirmed or suspected Marfan syndrome. Ann Thorac Surg 81:2063–2078

    Article  PubMed  Google Scholar 

  16. Mommertz G, Langer S, Koeppel TA et al (2009) Brain and spinal cord protection during simultaneous aortic arch and thoracoabdominal aneurysm repair. J Vasc Surg 49:886–892

    Article  PubMed  Google Scholar 

  17. Mommertz G, Sigala F, Langer S et al (2008) Thoracoabdominal aortic aneurysm repair in patients with marfan syndrome. Eur J Vasc Endovasc Surg 35:181–186

    Article  CAS  PubMed  Google Scholar 

  18. Quinones-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 30:555–560

    Article  CAS  PubMed  Google Scholar 

  19. Rigberg DA, Zingmond DS, McGory ML et al (2006) Age stratified, perioperative, and one-year mortality after abdominal aortic aneurysm repair: a statewide experience. J Vasc Surg 43:224–229

    Article  PubMed  Google Scholar 

  20. Roselli EE, Greenberg RK, Pfaff K et al (2007) Endovascular treatment of thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg 133:1474–1482

    Article  PubMed  Google Scholar 

  21. Schepens MA, Heijmen RH, Ranschaert W et al (2009) Thoracoabdominal aortic aneurysm repair: results of conventional open surgery. Eur J Vasc Endovasc Surg 37:640–645

    Article  CAS  PubMed  Google Scholar 

  22. Schlösser FJ, Mojibian H, Verhagen HJ et al (2008) Open thoracic or thoracoabdominal aortic aneurysm repair after previous abdominal aortic aneurysm surgery. J Vasc Surg 48:761–768

    Article  PubMed  Google Scholar 

  23. Verhoeven EL, Tielliu IF, Bos WT, Zeebregts CJ (2009) Present and future of branched stent grafts in thoraco-abdominal aortic aneurysm repair: a single-centre experience. Eur J Vasc Endovasc Surg 38:155–161

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenskonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Europäisches Gefäßzentrum Aachen-Maastricht, Universitätsklinikum der RWTH-Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    T.A. Koeppel, A. Greiner & M.J. Jacobs

Authors
  1. T.A. Koeppel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Greiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M.J. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T.A. Koeppel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koeppel, T., Greiner, A. & Jacobs, M. Thorakoabdominelle Aortenaneurysmen. Gefässchirurgie 15, 505–510 (2010). https://doi.org/10.1007/s00772-010-0849-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-010-0849-z

Schlüsselwörter

Keywords

Search

Navigation