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Periskop-, Kamin- und Sandwichtechnik sowie VORTEC zur Vereinfachung der Behandlung von Aneurysmen der Aorta abdominalis und thoracoabdominalis

Periscopes, chimneys, sandwich and VORTEC to facilitate abdominal and thoracoabdominal aortic aneurysm repair

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Zusammenfassung

VORTEC (Viabahn Open Revascularisation TEChnique) und die Kaminprothesentechnik sind Verfahren zur Erhaltung oder Wiederherstellung des Blutflusses von Aortenästen, die geplant oder als Notlösung bei offener Operation oder endovaskulärem Vorgehen eingesetzt werden können. VORTEC ist eine stentbasierte vaskuläre Verbindungstechnik zur Herstellung einer End-zu-End-Anastomose, die insbesondere geeignet ist, wenn die herkömmliche Nahttechnik schwierig ist (sein könnte). Es handelt sich um ein schnelles Verfahren, das praktisch ohne Blutflussunterbrechung und ohne Anastomosenblutung ist, die Durchgängigkeitsraten sind ähnlich gut wie bei Nahtanastomosen. Die Kamin-Periskop-Sandwich-Prothesentechnik (“chimney/periscope and sandwich graft technique”, CHIMPES) ist ein endovaskuläres Verfahren, bei dem parallele Endoprothesen zur Erhaltung oder Wiederherstellung des Blutflusses von Aortenästen verwendet werden, während ein herkömmlicher Aortenstent oberhalb ihres Ursprungs platziert wird. Es ist ein relativ schnelles Verfahren mit der Möglichkeit, selbst in Notfällen handelsübliche Produkte zu verwenden. Bei der Sandwichtechnik verlaufen parallele Prothesen zwischen 2 Aortenstents. Publizierten Erfahrungen zufolge scheinen diese beiden Techniken besonders für die Behandlung von Aneurysmen der Aortenäste und der Aorta thoracoabdominalis geeignet zu sein, vor allem in Hochrisiko- oder Akutfällen.

Die englische Volltextversion dieses Beitrags ist über SpringerLink (unter „Supplemental“) verfügbar.

Abstract

The VORTEC (VIABAHN open revascularization technique) and the chimney graft technique are tools with which to maintain or restore blood flow to the aortic branches and can be used intentionally or as a bailout procedure in open surgery or endovascular procedures. VORTEC is a stent graft-based vascular connection technique that achieves end-to-end anastomosis configuration; it is especially useful when the traditional suture technique proves (can be) cumbersome. It is also a speedy tool with virtually no blood flow interruption and no anastomotic bleeding, and patency rates compare favorably with sutured anastomosis. The chimney/periscope, as well as the sandwich graft technique (CHIMPES), is an endovascular tool using parallel endografts for maintaining or restoring blood flow to aortic branches, whereas the conventional aortic stent graft will land above their origin. It is a relatively speedy procedure allowing the use of off-the-shelf devices, even for emergency cases. When parallel grafts run in between two aortic stent graft devices, the term“sandwich” is used. Based on the published experience, both techniques seem particularly useful in aortic arch and thoracoabdominal aortic aneurysm repair, especially in high-risk or acute cases.

The English full-text version of this article is available at SpringerLink (under“Supplemental”).

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Authors and Affiliations

  1. Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich, Zürich, Schweiz

    F. Pecoraro, Z. Rancic, F.J. Veith, D. Mayer &  M. Lachat

  2. Interventionelle Radiologie, Universitätsspital Zürich, Zürich, Schweiz

    T. Pfammatter

  3. The Cleveland Clinic, Cleveland, USA

    F.J. Veith

  4. Diagnostische Radiologie, Universitätsspital Zürich, Zürich, Schweiz

    T. Frauenfelder

  5. Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster, Münster, Deutschland

    K.P. Donas

  6. New York University Medical Center, New York, USA

    F.J. Veith

  7. Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz

    M. Lachat

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  1. F. Pecoraro
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  2. Z. Rancic
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  3. T. Pfammatter
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  6. T. Frauenfelder
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  7. D. Mayer
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  8. M. Lachat
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Correspondence to M. Lachat.

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Pecoraro, F., Rancic, Z., Pfammatter, T. et al. Periskop-, Kamin- und Sandwichtechnik sowie VORTEC zur Vereinfachung der Behandlung von Aneurysmen der Aorta abdominalis und thoracoabdominalis. Gefässchirurgie 17, 632–639 (2012). https://doi.org/10.1007/s00772-012-1078-4

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