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Das isolierte Iliakaaneurysma – eine morphologische Klassifikation unter endovaskulären Gesichtspunkten

Isolated iliac artery aneurysms – a morphological classification from a endovascular viewpoint

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Zusammenfassung

Isolierte Iliakaaneurysmen sind eine seltene Form aortoabdominaler Aneurysmen und weisen eine hohe Komplikations- und Rupturrate auf, die mit einer hohen Mortalität einhergeht. Unspezifische Symptome verzögern die Diagnosestellung. Endovaskuläre Therapieoptionen haben sich neben offen-chirurgischen Verfahren mit vergleichbaren Ergebnissen etabliert. Die Multislice-CT-Angiographie hat eine entscheidende Bedeutung bei der Indikationsstellung zur endovaskulären Therapie, der Materialauswahl und der präinterventionellen Beschreibung kritischer Faktoren. Es wird eine morphologische Klassifikation des isolierten Iliakaaneurysmas vorgestellt, die anhand der Aneurysmamorphologie eine Entscheidungshilfe bei der Auswahl der geeignetsten endovaskulären Technik ist.

Abstract

Isolated iliac artery aneurysms, which are a rare form of aortoabdominal aneurysms, have a high complication and rupture rate, and are associated with high mortality. Unspecific clinical symptoms often make diagnosis difficult. Endovascular therapeutic options are established for the treatment of iliac aneurysms and are an alternative to open surgical repair with similar clinical outcome. Multislice CT angiography has an important role in determining the indication for endovascular therapy, the choice of materials, and the preinterventional description of risk factors. This paper proposes a new morphological classification of iliac artery aneurysms to assist in determining which endovascular technique is preferred based on aneurysm morphology.

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Literatur

  1. Leitlinien der Deutschen Gesellschaft für Gefäßchirurgie (vaskuläre und endovaskuläre Chirurgie) (DGG). Leitlinien zum Bauchaortenaneurysma und Beckenarterienaneurysma. http://www.awmf.org/uploads/txszleitlinien

  2. Sakamoto I et al (2005) Endovaskular treatment of iliac artery aneurysms. Radiographics 25:213–227

    Article  Google Scholar 

  3. Böckler D et al (2006) Chirurgisches Management des isolierten Beckenarterienaneurysmas. Zentralbl Chir 131:18–24

    Article  PubMed  Google Scholar 

  4. Nachbur BH, Inderbitzi RGC, Bär W (1991) Isolated iliac aneurysms. Eur J Vasc Surg 5:375

    Article  CAS  PubMed  Google Scholar 

  5. Levi N, Schroter T (1998) Isolated iliac artery aneurysms. Eur J Vasc Endovasc Surg 16:342–344

    Article  CAS  PubMed  Google Scholar 

  6. Reber PU, Hakki H, Stirnemann P, Kniemeyer HW (2001) Häufigkeit, Klassifikation und Therapie der isolierten Beckenarterienaneurysmen. Chirurg 72:419–424

    Article  CAS  PubMed  Google Scholar 

  7. Uberoi R et al (2011) Standard of practice for the Interventional management of isolated Iliac artery aneurysms. Cardiovasc Intervent Radiol 34:3–13

    Article  PubMed  Google Scholar 

  8. Krupski WC, Selzmann CH, Florida R et al (1998) Contemporary management of isolated iliac aneurysms. J Vasc Surg 28(1):1–11

    Article  CAS  PubMed  Google Scholar 

  9. Santilli SM, Wernsing SE, Lee ES (2000) Expansion rates and outcomes for iliac artery aneurysma. J Vasc Surg 31:114–121

    Article  CAS  PubMed  Google Scholar 

  10. Tiesenhausen K, Toma M, Baumann A (2003) Ruptur eines Aneurysmas der Arteria iliaca interna. Chirurg 74:1167–1169

    Article  CAS  PubMed  Google Scholar 

  11. Richardson JW, Greenfield LJ (1988) Natural history and management of iliac aneurysms. J Vasc Surg 18:165–171

    Google Scholar 

  12. Degen C, Heller G, Thouet R, Zellweger U (2012) Groteskes Iliakalaneurysma mit secundärer Hydronephrose. Schweiz Med Forum 11(16):330–331

    Google Scholar 

  13. Liewald F et al (2002) Verschluss der A. iliaca interna bei stentgestützter Ausschaltung Infrarenaler Aortenaneurysmen. Gefäßchirurgie 7:9–12

    Article  Google Scholar 

  14. Niklaus DU, Maurers H, Siebenman R, Zinnenlauf S (2008) Aneurysma der Arteria iliaca communis mit schmerzloser Perforation in die Vena cava – AV-Fistel mit massivem Rechts-Links-Shunt. Kardiovaskuläre Medizin 11(2):61–63

    Google Scholar 

  15. Vowden P, Wilkinson D, Ansolbsky JR, Keester RC (1989) A comparison of three imaging techniques in the assessment of an abdominal aortic aneurysm. J Cardiovasc Surg 30:891–896

    CAS  Google Scholar 

  16. Scheinert D, Schröder M, Steinkamp H et al (2000) Treatment of iliac artery aneurysms by percutaneous implantation of stent grafts. Circulation 102:253–258

    Article  Google Scholar 

  17. Chowdhury MM et al (2001) Modified stent assisted embolisation technique to treat an internal iliac artery aneurysm. Cardiovasc Intervent Radiol 33:1049–1051

    Article  Google Scholar 

  18. Caronno R (2006) Endovascular treatment of isolated iliac artery aneurysms. Ann Vasc Surg 20:496–501

    Article  PubMed  Google Scholar 

  19. Pitoulias A et al (2007) Isolated iliac artery aneurysms: endovascular versus open elektiv repair. J Vasc Surg 46:648–654

    Article  PubMed  Google Scholar 

  20. Patel NV, Long GW, Cheema ZF et al (2009) Open vs. endovascular repair of isolated iliac artery aneurysms: a 12-year experience. J Vasc Surg 49:1147–1153

    Article  PubMed  Google Scholar 

  21. Barlach JM, Slovut DP (2008) State of the art: management of iliac artery aneurismal disease. Catheter Cardiovasc Interv 71(5):708

    Article  Google Scholar 

  22. Chaer RA, Barbato JE, Lin SC et al (2008) Isolated iliac artery aneurysms: a contemporary comparison of endovascular and open repair. J Vasc Surg 47:708–713

    Article  PubMed  Google Scholar 

  23. Fahrni M, Lachat MM, Wildermuth S, Pfannmatter T (2003) Endovascular therapeutic options for isolated iliac aneurysms with a working classification. Cardiovasc Intervent Radiol 26:443–447

    Article  PubMed  Google Scholar 

  24. Kasirajan V, Hertzer NR, Beven EG et al (1998) Management of isolated common iliac artery aneurysmas.Cardiovasc Surg 6:171–177

    Article  CAS  PubMed  Google Scholar 

  25. Ruurda JP et al (2001) Continuing expansion of internal iliac aneurysms after surgical exclusion of the inflow. J Cardiovasc Surg 42:389

    CAS  Google Scholar 

  26. Kwaan JHM, Dahl DK (1984) Fatal rupture after successful surgical thrombosis of an abdominal aortic aneurysm. Surgery 95:235

    CAS  PubMed  Google Scholar 

  27. Huang Y et al (2008) Common iliac artery aneurysm: expansion rate and results of open surgical and endovascular repair. J Vasc Surg 47:1203–1211

    Article  PubMed  Google Scholar 

  28. Sandhu RS, Pipinos II (2005) Isolated iliac artery aneurysms. Semin Vasc Surg 18:209–215

    Article  PubMed  Google Scholar 

  29. Hechelhammer L, Ranck Z, Pfiffner R, Mayer D et al (2010) Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms. J Vasc Surg 52:1159–1163

    Article  PubMed  Google Scholar 

  30. Wyss TR, Dick F, Brown LC, Greenalgh RM (2011) The influence of thrombus, calcification, angulation, and tortuosity of attachement sites on the time to the first graftrelated complication after endovascular aneurysm repair. J Vasc Surg 54:965–971

    Article  PubMed  Google Scholar 

  31. Donas KP, Torsello G, Pitoulias G, Austermann M et al (2011) Surgical versus endovascular repair by iliac branch device of aneurysms involving the iliac bifurcation. J Vasc Surg 53:1223–1229

    Article  PubMed  Google Scholar 

  32. Ferreira M, Monteiro M, Lanziotti L (2010) Technical aspects and midterm patency of iliac branched devices. J Vasc Surg 51:545–550

    Article  PubMed  Google Scholar 

  33. Cormier F et al (2000) Endovascular treatment of iliac aneurysms with covered stents. Ann Vasc Surg 14:561–566

    Article  CAS  PubMed  Google Scholar 

  34. Parry DJ, Kessel D, Scott DJA (2001) Simplifying the internal iliac artery aneurysm. Ann R Coll Surg Engl 83:302–308

    CAS  PubMed Central  PubMed  Google Scholar 

  35. Peters AS, Bischoff MS, Meisenbacher K, Böckler D (2013) Management isolierter Iliakalaneurysmen. Gefässchirurgie 18:307–316

    Article  Google Scholar 

  36. Stroumpouli E et al (2007) The endovascular management of iliac artery aneurysms. Cardiovasc Intervent Radiol 30:1099–1104

    Article  PubMed  Google Scholar 

  37. Kritpracha B et al (2002) Bell-bottom aortoiliac endografts: an alternative that preserves pelvic blood flow. J Vasc Surg 35:874–881

    Article  PubMed  Google Scholar 

  38. Kirkwood ML, Saunders A, Jackson BM, Wang GJ et al (2011) Aneurysmal iliac arteries do not portend future iliac aneurismal anlargement after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg 53:269–273

    Article  PubMed  Google Scholar 

  39. Malagari K et al (2004) Large diameter limbs for dilated common iliac arteries in endovascular aneurysms repair: is it safe? Cardiovasc Intervent Radiol 27:237–242

    Article  PubMed  Google Scholar 

  40. Greenberg RK, Qureshi M (2010) Fenestrated and branched devices in the pipeline. J Vasc Surg 52:15–21

    Article  Google Scholar 

  41. Boules TN (2006) Endovascular management of isolated iliac artery aneurysms. J Vasc Surg 44:29–37

    Article  PubMed  Google Scholar 

  42. Faries VJ et al (2001) Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms. J Vasc Surg 34:892–899

    Article  CAS  PubMed  Google Scholar 

  43. Papazoglou KO, Sfyroeras GS, Zambas N et al (2012) Outcomes of endovascular aneurysm repair with selective iliac artery coverage without coil embolization. J Vasc Surg 56:298–304

    Article  PubMed  Google Scholar 

  44. Melas N, Saratzis A, Dixon H et al (2011) Isolated iliac artery Aneurysms: a revised classification to assist endovascular repair. J Endovasc Ther 18:697–715

    Article  PubMed  Google Scholar 

  45. Debus ES, Carpenter SW, Tsilimparis N et al (2013) Therapie des abdominalen Aortenaneurysmas. Internist (Berl) 54:543–551

  46. Strobl FF, Sommer WH, Haak M et al (2013) CT-Angiografie als Grundlage der optimierten Therapieplanung vor endovaskulärer Aneurysmaausschaltung. Radiologe 53:495–502

    Article  CAS  PubMed  Google Scholar 

  47. Schmidli J, Savolainen H, Heller G et al (2004) Chirurgie des Bauchaortenaneurysmas-offener Graftersatz versus endovaskuläre Therapie. Schweiz Med Forum 4:653–660

    Google Scholar 

  48. Gross-Fengels W (2013) Die Interventionelle/endovaskuläre Therapie des infrarenalen abdominellen Aortenaneurysmas. Radiologe 53:503–512

    Article  CAS  PubMed  Google Scholar 

  49. Heikkinen MA, Alsac JM, Arko FR et al (2006) The importance of iliac fixation in prevention of stent graft migration. J Vasc Surg 43:1130–1137

    Article  PubMed  Google Scholar 

  50. Bowman JN, Silverberg D, Ellozy S et al (2010) The role of anatomic factors in predicting success of endovascular repair of thoracic aortic aneurysms. Vasc Endovascular Surg 44:101–104

    Article  PubMed  Google Scholar 

  51. Jayalath RW, Mangan SH, Golledge J (2005) Aortic calcifikation. Eur J Vasc Endovasc Surg 30:476–488

    Article  CAS  PubMed  Google Scholar 

  52. Petrik PV, Moore WS (2001) Endoleaks following endovaskular repair of abdominal aortic aneurysm: the predictive value preoperative anatomic factors – a review of 100 cases. J Vasc Surg 33:739–744

    Article  CAS  PubMed  Google Scholar 

  53. Girlitz DB, Ramaswami G, Kaplan D et al (2001) Endovascular stent grafting in the presence of aortic neck filling defects: early clinical experience. J Vasc Surg 33:340–344

    Article  Google Scholar 

  54. Albertini J, Kalliafas S, Travis S et al (2000) Anatomical risc factors for proximal perigraft endoleak and graft migration following endovascular repair of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 19:308–312

    Article  CAS  PubMed  Google Scholar 

  55. Bastos Goncalves F, Verhagen HJM, Chinsakchai K et al (2012) The influence of neck thrombus on clinical outcome and aneurysm morphology after endovascular aneurysm repair. J Vasc Surg 56:36–44

    Article  Google Scholar 

  56. Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the society for Vascular Surgery practice guidelines. J Vasc Surg 50:S2–S49

    Article  PubMed  Google Scholar 

  57. Kölbel T, Larena-Avellaneda A, Carpenter SW et al (2011) Alternative Zugangswege zur abdominellen und thorakalen Aorta bei Aortenstentbehandlungen. Gefässchirurgie 16:160–167

    Article  Google Scholar 

  58. Tielliu IFJ, Zeebregts CJ, Dungen JJAM van den et al (2008) A modified technique for iliac artery branched endografting using a thromboned sheath. J Vasc Surg 48:1605–1608

    Article  PubMed  Google Scholar 

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Danksagung

Unser Dank gilt Herrn P. Wojcik aus dem Institut für Bildgebende Diagnostik des Asklepios Klinikums Uckermark GmbH für die Überlassung des Bildmaterials.

Einhaltung ethischer Richtlinien

Interessenkonflikt. F.-P. Pfabe, D. Hinc, D. Sud und M. Bach geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Gefäßmedizin, Asklepios Klinikum Uckermark Schwedt GmbH, Auguststr. 23, 16303, Schwedt, Deutschland

    F.-P. Pfabe, D. Hinc, D. Sud & M. Bach

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  1. F.-P. Pfabe
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  2. D. Hinc
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Correspondence to F.-P. Pfabe.

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Pfabe, FP., Hinc, D., Sud, D. et al. Das isolierte Iliakaaneurysma – eine morphologische Klassifikation unter endovaskulären Gesichtspunkten. Gefässchirurgie 19, 38–50 (2014). https://doi.org/10.1007/s00772-013-1266-x

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