Bauchaortenaneurysma – Diagnostik und interventionell-radiologische Therapie

Zusammenfassung

Das Bauchaortenaneurysma (BAA) als eine fokale Erweiterung aller Wandschichten der Aorta abdominalis ist ein komplexes und lebensbedrohliches Krankheitsbild – Albert Einstein und Charles de Gaulle sind an einer Ruptur verblutet. Eine endovaskuläre Aortenreparatur (EVAR) oder offen-chirurgische Therapie haben das Ziel, das Rupturrisiko niedrig zu halten bzw. zu eliminieren und die Lebenserwartung des Patienten zu verbessern.

Abstract

The abdominal aortic aneurysm is a complex, potentially life-threatening disease with high mortality rates up to 50%. Prominent examples of tragic courses include the death of Albert Einstein and Charles de Gaulle who died from rupture. Recently, several trials have been conducted in order to compare the relative benefits and disadvantages of modern diagnostic methods and endovascular aneurysm repair to those of traditional open surgery. This review attempts to deal with the puzzle of modern radiological imaging and treatment strategies of abdominal aortic aneurysms.

Kernaussagen

• Das Bauchaortenaneurysma wird heute häufiger endovaskulär als offen-chirurgisch therapiert, nicht zuletzt, da sowohl die 30-Tage-Mortalität als auch die Hospitalisierungsdauer der offen-chirurgischen Therapie signifikant höher liegen.

• Die Therapieindikation und der zeitliche Rahmen der Aneurysmabehandlung beruhen auf der klinischen Symptomatik, der Aneurysmagröße und dem resultierenden Rupturrisiko.

• Die häufigste Komplikation nach EVAR sind Endoleaks mit 10 – 50%; die Endoleak-Typen I und III erfordern aufgrund des erhöhten Rupturrisikos eine rasche Ausschaltung, ebenso Typ-II-Endoleaks mit Größenzunahme des Aneurysmasackes.

• Der Farbdoppler-/kontrastverstärkte Ultraschall sowie die MRA sind strahlenfreie Alternativen zur CTA in der Verlaufskontrolle von Bauchaortenaneurysmen. Unabhängig von der gewählten Bildgebung sind lebenslang regelmäßige Kontrollen notwendig.

Schlüsselwörter

Bauchaortenaneurysma - BAA - EVAR - FEVAR - BEVAR - chEVAR

Key words

abdominal aortic aneurysm - EVAR - FEVAR - BEVAR - chEVAR

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