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Behandlungsstrategien der chronischen Typ-B-Aortendissektion

Treatment strategies for chronic Type B aortic dissection

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Zusammenfassung

Hintergrund

Die chronische Typ-B-Aortendissektion ist eine komplexe Erkrankung, die individuelle therapeutische Strategien benötigt und bei der andere Therapieansätze als bei der Behandlung von akuten oder subakuten Typ-B-Dissektionen erforderlich sind. Therapieindikationen ergeben sich vor allem aus einer persistierenden Falschlumenperfusion mit Aneurysmabildung. Eine weitere Herausforderung bei der Therapie chronischer Typ-B-Aortendissektionen ist die zunehmende Rigidität und Verhärtung der Dissektionslamelle, die ein Remodeling der Aorta erschwert.

Ziel

Dieser Artikel gibt eine Übersicht über die chronische Typ-B-Aortendissektion und die aktuellen konservativen, offen-chirurgischen und insbesondere endovaskulären Therapiemöglichkeiten dieser Erkrankung.

Material und Methoden

Einbeziehung der aktuellen Literatur zur Therapie der chronischen Typ-B-Aortendissektion sowie Beschreibung neuer endovaskulärer Techniken.

Ergebnisse

Neben offen-chirurgischen Therapieoptionen, gewinnen endovaskuläre Techniken bei der Behandlung der chronischen Typ-B-Aortendissektion zunehmend an Bedeutung, insbesondere bei multimorbiden Patienten. Die Falschlumenokklusion spielt eine wichtige Rolle für den Therapieerfolg.

Schlussfolgerung

Die chronische Typ-B-Aortendissektion ist eine komplexe Erkrankung mit vielen Aspekten, bei der die alleinige Behandlung mittels thorakalem Stentgraft oft nicht ausreicht. Die schnelle Entwicklung neuer endovaskulärer Techniken bahnt neue Optionen zur Therapie dieser Krankheit.

Abstract

Background

Chronic Type B aortic dissection is a complex disease that needs individual treatment strategies and different considerations than therapy of acute or subacute Type B aortic dissection. Indications for therapy are mainly derived from persistent false lumen perfusion with aneurysm formation. Another challenge for the treatment of chronic Type B aortic dissection is the increasing rigidity and thickness of the dissection membrane, which reduces the aortic remodeling capacity.

Objective

This article gives an overview of chronic Type B aortic dissection and summarizes current treatment strategies in regard to conservative, open surgical and especially endovascular approaches.

Material and methods

Evaluation of the current literature with respect to treatment strategies for chronic Type B aortic dissection as well as descriptions of new endovascular techniques.

Results

Endovascular techniques are becoming more important for the treatment of chronic Type B aortic dissection, especially in multimorbid patients. False lumen occlusion plays an important role in treatment success.

Conclusion

Chronic Type B aortic dissection is a challenging disease as the pathology is associated with several features which make standard thoracic endovascular aortic repair (TEVAR) procedures barely sufficient. The rapid development in endovascular techniques provides new directions for the treatment of this disease.

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Authors and Affiliations

  1. Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    F. Rohlffs, N. Tsilimparis, K. Stoberock, E.S. Debus & T. Kölbel

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  1. F. Rohlffs
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  2. N. Tsilimparis
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  3. K. Stoberock
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  4. E.S. Debus
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Correspondence to F. Rohlffs.

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Interessenkonflikt

F. Rohlffs, N. Tsilimparis, K. Stoberock, E.S. Debus und T. Kölbel geben an, dass in Hinblick auf die in diesem Artikel diskutierten Inhalte kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Rohlffs, F., Tsilimparis, N., Stoberock, K. et al. Behandlungsstrategien der chronischen Typ-B-Aortendissektion. Gefässchirurgie 20, 435–440 (2015). https://doi.org/10.1007/s00772-015-0074-x

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