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Möglichkeiten der künstlichen Kreislaufumleitung in der Chirurgie der großen Arterien

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Aorta und große Arterien

Zusammenfassung

Während des vergangenen Jahrzehntes hat die Entwicklung neuartiger Hilfsmittel die Möglichkeiten der Gefäßchirurgie in einem solchen Ausmaß erweitert, daß die meisten Erkrankungen der großen Arterien einer erfolgversprechenden operativen Therapie zugänglich geworden sind. Hypothermie, künstliche Kreislaufumleitung und alloplastischer Gefäßersatz haben gleichermaßen dazu beigetragen, die Gefahren einer langfristigen Zirkulationsunterbrechung zu lebenswichtigen Organen zu verringern bzw. gänzlich zu beseitigen. Durch Verwendung von Oberflächenunterkühlung gelang es, das Risiko der Kontinuitätsresektion an der Aorta descendens [60, 62, 81, 111, 179, 194] und am Aortenbogen [59, 60, 173] wesentlich zu vermindern. Mit Hilfe von extrakorporalen Kreislaufanordnungen wurde die rekonstruktive Chirurgie der Aorta ascendens erschlossen [61, 64]. Der alloplastische Gefäßersatz ergänzte in zunehmendem Maße sowohl das Vorgehen unter Hypothermie wie die Technik der künstlichen Kreislaufüberbrückung. In der Folge hat die Oberflächenunterkühlung in der vasculären wie in der kardialen Chirurgie zugunsten extrakorporaler Kreislaufumleitungen an Bedeutung verloren. Angesichts dieser Entwicklung sollen die nachfolgenden Ausführungen im wesentlichen auf die Anwendungsmöglichkeiten der verschiedenen Formen der künstlichen Kreislaufumleitung und die mit ihrem Einsatz verbundenen pathophysiologischen Probleme beschränkt bleiben.

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Borst, H.G. (1966). Möglichkeiten der künstlichen Kreislaufumleitung in der Chirurgie der großen Arterien. In: Aorta und große Arterien. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-49155-9_6

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