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Aortendissektion Typ B – Definitionen, Inzidenz, Ätiologie

Aortic dissection type B: definition, incidence, etiology

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Zusammenfassung

Die Aortendissektion ist die häufigste Notfallsituation im Bereich der Aorta mit steigender Inzidenz (7 Fälle auf 100.000 Einwohner in Deutschland) und kommt damit mehr als doppelt so häufig vor wie das rupturierte abdominelle Aortenaneurysma. Sie ist definiert durch das Vorliegen eines Intimaeinrisses (proximales Entry) mit Ausbildung eines falschen Lumens und meist mehreren Reentries. Die Typ-B-Dissektion (nach der Stanford-Einteilung) macht ca. 30 % aller Aortendissektionen aus und liegt dann vor, wenn die thorakale Aorta ohne Beteiligung der Aorta aszendens betroffen ist. Eine Indikation zur invasiven Behandlung der Typ-B-Dissektion wird bei Ausbildung von Komplikationen (= komplizierte Typ-B-Dissektion) gesehen, u. a. bei drohender oder vorhandener Ruptur, Malperfusions-Syndrom oder Aneurysmaausbildung. Trotz Fortschritte in der Medizin hat sich das Überleben der Patienten mit konservativ behandelter Typ-B-Dissektion über die letzten 15 Jahre nicht verbessert, sodass intensiv diskutiert wird, welche Patientengruppe von einer frühzeitigen endovaskulären Behandlung profitiert.

Abstract

Aortic dissection is the most common emergency situation in the area of the aorta with an increasing incidence (7 out of 100,000 population in Germany) and is, therefore, more than twice as frequent as ruptured abdominal aortic aneurysms. Aortic dissection is defined as the presence of an intimal tear (proximal entry) with formation of a false lumen and in most cases several reentries. Type B dissections (according to the Stanford classification) constitute approximately 30 % of all aortic dissections and occur when the thoracic aorta is affected without involvement of the ascending aorta. An indication for invasive treatment of type B dissections is present when complications occur (complicated type B dissection), especially with the threat or presence of a rupture, malperfusion syndrome or aneurysma formation. Despite the progress in medicine the survival of patients with conservative treatment of type B dissections has not improved over the last 15 years so that there is intensive discussion on which patient groups profit from a timely endovascular treatment.

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Authors and Affiliations

  1. Klinik für Gefäßmedizin, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Deutschland

    C.M. Bünger & A. Knop

  2. Klinik für Kardiologie und konservative Intensivmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland

    S. Kische & H. Ince

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  1. C.M. Bünger
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  2. A. Knop
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  3. S. Kische
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  4. H. Ince
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Correspondence to C.M. Bünger.

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C.M. Bünger, A. Knop, S. Kische und H. Ince geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Bünger, C., Knop, A., Kische, S. et al. Aortendissektion Typ B – Definitionen, Inzidenz, Ätiologie. Gefässchirurgie 20, 415–419 (2015). https://doi.org/10.1007/s00772-015-0075-9

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