Zusammenfassung
Die akute Typ-B-Dissektion der Aorta ist ein gefürchtetes Krankheitsbild. Gegenüber früheren Therapieansätzen hat sich die endovaskuläre Stentgraftstabilisierung der Aortenwand durchgesetzt. Die orthograde Perfusion der linken A. subclavia sollte erhalten bzw. durch Transposition wiederhergestellt werden. Im aortalen Viszeralsegment werden bei entsprechender Notwendigkeit Stent-PTAs der Intestinal- und Nierenarterien empfohlen, um die Durchblutung und Funktion der Erfolgsorgane sicherzustellen.
Summary
Acute type B dissection is a common lethal aortic disease. Compared to former therapeutic strategies aortic wall stabilization by endovascular stent grafting became widely accepted. Antegrade perfusion of the left subclavian artery should be preserved or reconstructed by transposition. In case of malperfusion after aortic dissection stenting of visceral or renal branches is recommended to preserve perfusion and function of depending organs.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Literatur
Barnes DM, Williams DM, Dasika NL, Patel HJ, Weder AB, Stanley JC, Deeb GM, Upchurch GR Jr (2008) A singlecenter experience treating renal malperfusion after aortic dissection with central aortic fenestration and renal artery stenting. J Vasc Surg 47: 903–910
Böckler D, Schumacher H, Ganten M, von Tengg-Kobligk H, Schwarzbach M, Fink C, Kauczor HU, Bardenheuer H, Allenberg JR (2006) Complications after endovascular repair of acute and chronic Stanford type B aortic dissections. J Thorac Cardiovasc Surg 132: 361–368
Böckler D, Hyhlik-Dürr A, Hakimi M, Weber TF, Geisbüsch P (2009) Type B aortic dissections: treating the many to benefit the few? J Endovasc Ther 16 (Suppl 1): 80–90
Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE (1970) Management of acute aortic dissection. Ann Thorac Surg 10: 237–247
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP (1994) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331: 1729–1734
DeBakey ME, McCollum CH, Crawford ES, Morris GC Jr, Howell J, Noon GP, Lawrie G (1982) Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twentyseven patients treated surgically. Surgery 92: 1118–1134
De Latour B, Delaunay R, Rivalan J, Heautot JF, Verhoye JP (2007) Stent-graft repair for aortic type B dissections with insidious renal malperfusion. J Thorac Cardiovasc Surg 134: 1342–1343
Eggebrecht H, Thompson M, Rousseau H, Czerny M, Lönn L, Mehta RH, Erbel R, European Registry on Endovascular Aortic Repair Complications (2009) Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation 120 (Suppl 11): S276–281
Fattori R, Botta L, Lovato L, Biagini E, Russo V, Casadei A, Buttazzi K (2008) Malperfusion Syndrome in Type B Aortic Dissection: Role of the Endovascular Procedures. Acta Chir Belg 108: 192–197
Feezor RJ, Martin TD, Hess PJ Jr, Beaver TM, Klodell CT, Lee WA (2009) Early outcomes after endovascular management of acute, complicated type B aortic dissection. J Vasc Surg 49: 561–566
Greenberg R, Khwaja J, Haulon S, Fulton G (2003) Aortic dissections: new perspectives and treatment paradigms. Eur J Vasc Endovasc Surg 26: 579–586
Neuhauser B, Greiner A, Jaschke W, Chemelli A, Fraedrich G (2008) Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection. Eur J Cardiothorac Surg 33: 58–63
Oderich GS, Panneton JM (2002). Acute aortic dissection with side branch vessel occlusion: open surgical options. Semin Vasc Surg 15: 89–96
Quinones-Baldrich W, Jimenez JC, DeRubertis B, Moore WS (2009) Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience. J Vasc Surg 49: 1125–1134
Rehders TC, Petzsch M, Ince H, Kische S, Körber T, Koschyk DH, Chatterjee T, Weber F, Nienaber CA (2004) Intentional occlusion of the left subclavian artery during stent-graft implantation in the thoracic aorta: Risk and relevance. J Endovasc Ther 11: 659–666
Safi HJ, Miller CC III, Readon MJ, Iliopoulos DC, Letsou GV, Espada R, Baldwin JC (1998) Operation of acute and chronic aortic dissection: Recent outcome with regard to neurologic deficit and early death. Ann Thorac Surg 66: 402–411
Szeto WY, McGarvey M, Pochettino A, Moser GW, Hoboken A, Cornelius K, Woo EY, Carpenter JP, Fairman RM, Bavaria JE (2008) Results of a new surgical paradigm: endovascular repair for acute complicated type B aortic dissection. Ann Thorac Surg 86: 87–89
Uchida N, Shibamura H, Katayama A, Aishin K, Sutoh M, Kuraoka M (2009) Surgical strategies for organ malperfusions in acute type B aortic dissection. Interact Cardiovasc Thorac Surg 8: 75–78
Winnerkvist A, Lockowandt U, Rasmussen E, Rådegran K (2006) A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg 32: 349–355
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Nowak, T., Luther, B., Kempf, U., Krasniqi, H. (2011). Erfolgreiche endovaskuläre Therapie bei Aortendissektion und dissezierter Nierenarterie. In: Rückert, R.I., Hepp, W., Luther, B. (eds) Chirurgie der abdominalen und thorakalen Aorta. Berliner Gefäßchirurgische Reihe, vol 11. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11719-0_27
Download citation
DOI: https://doi.org/10.1007/978-3-642-11719-0_27
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-11718-3
Online ISBN: 978-3-642-11719-0
eBook Packages: Medicine (German Language)