Zusammenfassung
Die Inzidenz von Aortenanomalien beträgt bis zu 26%. Sie entstehen im Rahmen der Embryogenese durch eine konsekutive Reihe von sog. Migrationen, Fusionen und Atrophien der embryonalen primären Aortenanlage. Diese Fehlanlagen bzw. Varianten sind selten symptomatisch und werden meist im Rahmen der Schnittbildgebung diagnostiziert. Kenntnisse dieser Aortenanomalien sind für die offen-chirurgische, aber v. a. für die endovaskuläre Therapie (TEVAR) sinnvoll und notwendig. Die hier behandelten Pathologien beziehen in über 50% der Fälle den Aortenbogen mit ein. Der folgende Artikel gibt einen Überblick über die häufigsten Aortenanomalien, die für Gefäßchirurgen klinische Relevanz besitzen.
Abstract
The development of the human aorta is accomplished through a series of migrations, fusions, atrophies and hypertrophies of the primitive embryonal vasculature. Complex and multiple modifications from the primitive aorta finally result in the adult configuration and are the basis of congenital maldevelopment or anomalies in the great vessels. The incidence of variants and aortic malformations is as high as 26%. Dyspnea and dysphagia are potential leading symptoms from arch anomalies and hypertension syndrome from abdominal aortic coarctation but most patients remain asymptomatic. Knowledge of embryology and anatomy of the aorta is clinically important and not only for radiology, cardiology and heart surgery. Especially in endovascular therapy of aortic diseases, planning of surgical and endovascular procedures depends on anatomical considerations and morphology as more than 50% of thoracic aortic diseases involve the arch with its supraaortic branches. This manuscript gives an overview and insights on relevant aortic anomalies to clinicians and surgeons in the field of vascular medicine.
Literatur
Siegel MJ, Smithuis R (2007) Vascular anomalies of aorta, pulmonary and systemic vessels. http://www.radiologyassistant.nl/en/p4718c7f2eb7cc/vascular-anomalies-of-aorta-pulmonary-and-systemic-vessels.html
Böckler D (2009) Der Aortenbogen – die therapeutische Herausforderung der nächsten Jahre. Gefässchirurgie 14:79
Yoshida RA, Kolvenbach R, Yoshida WB et al (2011) Total endovascular debranching of the aortic arch. Eur J Vasc Endovasc Surg 42(5):627–630
Kallenbach K, Kojic D, Oezsoez M et al (2013) Treatment of ascending aortic aneurysms using different surgical techniques: a single-centre experience with 548 patients. Eur J Cardiothorac Surg [Epub ahead of print]
Kolvenbach RR, Karmeli R, Pinter LS et al (2011) Endovascular management of ascending aortic pathology. J Vasc Surg 53(5):1431–1437
Shrestha M, Baraki H, Maeding I et al (2012) Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg 41(1):56–61
Dake MD, Miller DC, Semba CP et al (1992) Transluminal placement of endovascular stent-grafts for the treatment of descending aortic aneurysms. N Engl J Med 331:1729–1735
Nienaber CA, Fattori R, Lund G et al (1999) Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 240(20):1539–1545
Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5(6):491–499
Geisbüsch P, Kotelis D, Hyhlik-Dürr A et al (2010) Endografting in the arch – does the proximal landing zone influence outcome? Eur J Vasc Endovasc Surg 39:693–699
Mitchell RS, Ishimaru S, Ehrlich MP et al (2002) First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther 9(Suppl 2):II98–II105
Barry A (1951) The aortic arch derivates in the human adult. Anatom Rec 3:221–238
Congdon ED (1922) Transformation of the aortic arch system during development of the human embryo. Contrib Embryol 14:47–110
Steward JR, Kincaid OW, Edwards JE (1964) An atlas of vascular rings and related malformation of the aortic arch system. Charles C. Thomas, Springfield, S 3–129
Felson B, Palayew MJ (1963) The two types of right aortic arch. Radiology 81:745–759
Khatri R, Maud A, Rodriguez JG (2010) Aberrant right subclavian artery and common carotid trunk. J Vasc Interv Neurol 3:33–34
Kommerell B (1936) Verlagerung des Oesophagus durch eine abnorm verlaufende Arteria subclavia dextra (Arteria lusoria). Fortsch Geb Roentgenstrahlen 54:590–595
Adachi I, Krishnamurthy R, Morales LS (2011) A double aortic arch mimicking a right aortic arch with an aberrant subclavian artery. J Vasc Surg 45:1151–1153
Cina SC, Arena GO, Bruin G, Clase CM (2000) Kommerell’s diverticulum and aneurismal right sided aortic arch: a case report and review of the literature. J Vasc Surg 32:1208–1214
Chiesa R, Melissano G, Bertoglio L, Caliari F (2007) Hybrid repair of an aortic arch aneurysm with complex anatomy: right aortic arch and anomalous origin of supra aortic vessels. J Vasc Surg 46:128–130
Uppu SC, Shinkawa T, Imamura M (2012) Single institution experience with a right-sided interrupted aortic arch. Interact Cardiovasc Thorac Surg 15(4):802–804
Takano H, Ohnishi K, Ohkubo N et al (1993) Successful management of thoracic aortic aneurysm in a right sided aortic arch. Cardiovsac Surg 1:442–444
Andersen ND, Barfield ME, Hanna JM et al (2013) Intrathoracic subclavian artery aneurysm repair in the thoracic endovascular aortic repair era. J Vasc Surg 57(4):915–925
Kopp R, Däbritz S, Weidenhagen R et al (2008) Extrathorakal zervikalendovaskuläre Hybridoperation zur Behandlung der symptomatischen und/oder aneurysmatischen A. lusoria. Gefässchirurgie 13:179–188
Frigatti P, Grego F, Deriu G, Lepidi S (2009) Hybrid endovascular treatment of aneurysm degeneration in a rare right-aortic arch anomaly with Kommerell diverticulum. J Vasc Surg 50:903–906
Strife JL, Bisset GS III, Burrows PE (1998) Cardiovascular system. In: Kirks DR (ed) Practical pediatric radiology, 3rd ed. Lippincot-Raven, Philadelphia, pp 511–613
Kische S, Schneider H, Akin I et al (2010) Technique of interventional repair in adult aortic coarctation. J Vasc Surg 51(6):1550–1559
Jacob T, Modgil V, Rana K, Das S (2008) Multiple vascular anomalies in the abdomen – a gross anatomical study. Int J Morphol 26:563–566
Lewis SJ (2005) Vascular anomalies of first and second unpaired branches of the abdominal aorta. A case study. Clin Anat 4:219–222
Ramesh Rao T, Rachana (2011) Aberrant renal arteries and its clinical significance: a case report. Int J Anatomical Variations 4:37–39
Saldarriage B, Pinto SA, Ballesteros LE (2008) Morphological expression of the renal artery. Int J Morphol 26:31–38
Cho JS, Makaroun MS (2010) Thoracic and thoracoabdominal aortic aneurysms: endovascular treatment. In: Rutherford’s vascular surgery, 7th ed. Philadelphia:Saunders Elsevier, p. 2057
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Interessenkonflikt. D. Böckler und R. Kolvenbach geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Böckler, D., Kolvenbach, R. Anomalien der Aorta und ihre Bedeutung für den klinischen Alltag. Gefässchirurgie 18, 415–428 (2013). https://doi.org/10.1007/s00772-013-1191-z
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DOI: https://doi.org/10.1007/s00772-013-1191-z