Therapie primärer Aneurysmen der Extremitätenarterien

Periphere arterielle Aneurysmen sind seltene Gefäßerkrankungen, die grundsätzlich an sämtlichen Gefäßen auftreten können. Für die Therapieplanung müssen insbesondere individuelle Behandlungskriterien wie die Morphologie des Aneurysmas, die anatomische Lokalisation, besonders in Bezug auf bewegliche Segmente, der Gefäßabstrom und der Allgemeinzustand des Patienten berücksichtigt werden.

Kernaussagen

• Periphere arterielle Aneurysmen sind seltene Gefäßerkrankungen, bei denen das betroffene Gefäßsegment auf mindestens das 1,5-Fache des nativen Gefäßdurchmessers dilatiert ist.

• Grundsätzlich können primäre Aneurysmen an sämtlichen arteriellen Gefäßen auftreten.

• Die diagnostischen Verfahren umfassen neben der Duplexsonografie die CT- und MR-Angiografie sowie die digitale Subtraktionsangiografie. Von essenzieller Bedeutung ist es, im Rahmen der Diagnostik die Morphologie des Aneurysmas und die Zu- und Abstromverhältnisse möglichst exakt abzubilden.

• Die häufigste Entität peripherer Aneurysmen sind Poplitealarterienaneurysmen, die eine hohe Koinzidenz mit Aortenaneurysmen haben. Im Rahmen von Bindegewebserkrankungen oder Autoimmunerkrankungen können periphere arterielle Aneurysmen gehäuft auftreten (Ehlers-Danlos-Syndrom, Marfan-Syndrom, Morbus Behçet).

• Therapeutisch stehen als aktueller Therapiestandard offen chirurgische Verfahren zur Verfügung, aber auch endovaskuläre Therapieansätze sind beschrieben.

• Aktuell bietet die Literatur aufgrund der Seltenheit der Erkrankungen keine gute Evidenz zum Vergleich beider Verfahren. Für das Poplitealarterienaneurysma zeichnet sich aufgrund von mehreren Registerstudien und Singlecenterstudien ab, dass bei strenger Patientenselektion die endovaskuläre Therapie ein vergleichbares Outcome zur offenen Therapie bieten kann, wenngleich die offene Chirurgie therapeutischer Standard bleibt.

• Für die Therapieplanung arterieller Aneurysmen an den Extremitäten müssen individuelle Behandlungskriterien berücksichtigt werden, etwa

  • aneurysmabedingte klinische Symptomatik,

  • die Morphologie des Aneurysmas,

  • die anatomische Lokalisation, besonders in Bezug auf bewegliche Segmente,

  • der Gefäßabstrom und

  • der Allgemeinzustand des Patienten.

Schlüsselwörter

Gefäßchirurgie - periphere Aneurysmen - Poplitealarterienaneurysma - endovaskulär

Publication History

Article published online:
26 February 2020

• Literatur

• 1 Callum KG, Lea Thomas M, Browse NL. A definition of arteriomegaly and the size of arteries supplying the lower limbs. Br J Surg 1983; 70: 524-529
• 2 Dawson J, Fitridge R. Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene – is rupture really a danger?. Prog Cardiovasc Dis 2013; 56: 26-35
• 3 American College of Cardiology Foundation, American Heart Association. ACCF/AHA Pocket Guideline November 2011: Management of Patients with peripheral Artery Disease. Im Internet: (Stand: 01.10.2019) http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@spub/documents/downloadable/ucm_436821.pdf
• 4 Pittathankal AA, Dattani R, Magee TR. et al. Expansion rates of asymptomatic popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2004; 27: 382-384
• 5 Debus S, Groß-Fengels W. Operative und interventionelle Gefäßmedizin. 2. Aufl.. Berlin, Heidelberg: Springer; 2012
• 6 Koné-Paut I, Yurdakul S, Bahabri SA. et al. Clinical features of Behçetʼs disease in children: an international collaborative study of 86 cases. J Pediatr 1998; 132: 721-725
• 7 Demircioğlu KılıcB, Akbalık KaraM, Ozcelik AA. et al. Brachial artery pseudoaneurysm: rare finding in childhood Behcetʼs disease. Pediatr Int 2017; 58: 109-110
• 8 Zhang SH, Zhang FX. Behcetʼs disease with recurrent thoracic aortic aneurysm combined with femoral artery aneurysm: a case report and literature review. J Cardiothorac Surg 2017; 12: 79
• 9 Guzmán M, Amilcar C, Marín M. et al. Preliminary analysis of the association of TRPV1 to the formation of Marfan syndrome aneurysms. 2019 Im Internet: (Stand: 01.10.2019); [epublished ahead of print, non edited] https://www.hh.um.es/Articles-Proofs/18–127-manuscript.pdf
• 10 Aghoutane N, Bakkali T, Zoulati M. et al. An axillary-subclavian artery aneurysm in pre-rupture revealing Marfan syndrome. J Med Vasc 2019; 44: 71-75
• 11 Ghonem ME, Yuan X, Mitsis A. et al. Interventional repair of a vascular aneurysm in a patient with Marfan syndrome. SAGE Open Med Case Reports 2018; 6: 2050313X18788448
• 12 Saito Y, Taniguchi S, Watanabe K. et al. Bilateral axillary arterial aneurysms in siblings with Marfan syndrome. Ann Vasc Surg 2014; 28: 740.e13-740.e16
• 13 Tetik O, Yilik L, Besir Y. Surgical Treatment of Axillary Artery Aneurysm. Tex Heart Inst J 2005; 32: 186-188
• 14 Yasuda S, Imoto K, Uchida K. et al. Subclavian artery aneurysm in a patient with vascular Ehlers-Danlos syndrome. Asian Cardiovasc Thorac Ann 2016; 24: 187-189
• 15 Eagleton MJ. Arterial complications of vascular Ehlers-Danlos syndrome. J Vasc Surg 2016; 64: 1869-1880
• 16 Oderich GS, Panneton JM, Bower TC. et al. The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a 30-year experience. J Vasc Surg 2005; 42: 98-106
• 17 Johnston KW, Rutherford RB, Tilson MD. et al. Suggested standards for reporting on arterial aneurysms. J Vasc Surg 1991; 13: 452-458
• 18 Hardy DG, Eadie DG. Femoral aneurysms. Br J Surg 1972; 59: 614-616
• 19 Cutler BS, Darling RC. Surgical management of arteriosclerotic femoral aneurysms. Surgery 1973; 74: 764-773
• 20 Hall HA, Minc S, Babrowski T. Peripheral artery aneurysm. Surg Clin North Am 2013; 93: 911-923
• 21 Amer N, Grocott E, Shami S. Time for a new classification of femoral artery aneurysm?. Vasa 2004; 33: 170-172
• 22 Leon Jr. LR, Taylor Z, Psalms SB. et al. Degenerative aneurysms of the superficial femoral artery. Eur J Vasc Endovasc Surg 2008; 35: 332-340
• 23 Sharma S, Nalachandran S. Isolated common femoral artery aneurysm: a case report. Cases J 2009; 2: 7522
• 24 Jarrett F, Makaroun MS, Rhee RY. et al. Superficial femoral artery aneurysms: an unusual entity?. J Vasc Surg 2002; 36: 571-574
• 25 Savolainen H, Widmer MK, Heller G. et al. Common femoral artery – uncommon aneurysms. Scand J Surg 2003; 92: 203-205
• 26 Corriere MA, Guzman RJ. True and false aneurysms of the femoral artery. Semin Vasc Surg 2005; 18: 216-223
• 27 Tielliu IF, Zeebregts CJ, Vourliotakis G. et al. Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair. J Vasc Surg 2010; 51: 1413-1418
• 28 Pulcini G, Cimaschi D, Vinco A. et al. Rupture of voluminous atherosclerotic superficial femoral artery aneurysm. Chir Ital 2005; 57: 661-667
• 29 Rigdon EE, Monajjem N. Aneurysms of the superficial femoral artery: a report of two cases and review of the literature. J Vasc Surg 1992; 16: 790-793
• 30 Levi N, Schroeder TV. Arteriosclerotic femoral artery aneurysms. A short review. J Cardiovasc Surg (Torino) 1997; 38: 335-338
• 31 Dimakakos PB, Tsiligiris V, Kotsis T. et al. Atherosclerotic aneurysms of the superficial femoral artery: report of two ruptured cases and review of the literature. Vasc Med 1998; 3: 275-279
• 32 Moskowitz R, Clabeaux G, Swartz A. et al. A rare case of a giant superficial femoral artery aneurysm. J Vasc Surg 2016; 64: 809
• 33 Siani A, Flaishman I, Napoli F. et al. Rupture of an isolated true superficial femoral artery aneurysm: case report. G Chir 2005; 26: 215-217
• 34 Lawrence PF, Harlander-Locke MP, Oderich GS. et al. The current management of isolated degenerative femoral artery aneurysms is too aggressive for their natural history. J Vasc Surg 2014; 59: 343-349
• 35 Mufty H, Daenens K, Houthoofd S. et al. Endovascular treatment of isolated degenerative superficial femoral artery aneurysm. Ann Vasc Surg 2018; 49: 311.e11-311.e14
• 36 Tam M, Ahnood D, Tanqueray A. et al. Endovascular treatment of a superficial femoral artery aneurysm using an Amplatzer Vascular Plug. Diagnostic Interv Radiol 2013; 19: 516-517
• 37 Flückiger R, Koella C, Huber A. True aneurysm of the femoral profunda artery. Vasa 1996; 25: 279-286
• 38 Ahmad W, Majd P, Luebke T. et al. Clinical outcome after surgical and endovascular treatment of symptomatic persistent sciatic artery with review of the literature and reporting of three cases. Vascular 2016; 24: 469-480
• 39 Wang Y, Xin H, Tan H. et al. Endovascular stent graft repair of complete persistent sciatic artery aneurysm with lower limb ischemia: a case report and review of the literature. SAGE Open Med Case Reports 2019; 7
• 40 Trickett JP, Scott RA, Tilney HS. Screening and management of asymptomatic popliteal aneurysms. J Med Screen 2002; 9: 92-93
• 41 Dawson I, Sie RB, Van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg 1997; 84: 293-299
• 42 Sandgren T, Sonesson B, Ryden-Ahlgren Å. et al. Arterial dimensions in the lower extremities of patients with abdominal aortic aneurysms – no indications of a generalized dilating diathesis. J Vasc Surg 2001; 34: 1079-1084
• 43 Tuveson V, Löfdahl HE, Hultgren R. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms. Vasc Med 2016; 21: 369-375
• 44 Schmitz-Rixen T, Debus ES, Torsello G. et al. Poplitealarterienaneurysma – Was ist die beste Behandlungsoption?. Gefässchirurgie 2014; 19: 459-466
• 45 Björck M, Beiles B, Menyhei G. et al. Editorʼs choice: Contemporary treatment of popliteal artery aneurysm in eight countries: a report from the Vascunet collaboration of registries. Eur J Vasc Endovasc Surg 2014; 47: 164-171
• 46 Galland RB, Magee TR. Popliteal aneurysms: distortion and size related to symptoms. Eur J Vasc Endovasc Surg 2005; 30: 534-538
• 47 Michaels JA, Galland RB. Management of asymptomatic popliteal aneurysms: The use of a Markov decision tree to determine the criteria for a conservative approach. Eur J Vasc Surg 1993; 7: 136-143
• 48 Dawson I, van Bockel JH, Brand R. et al. Popliteal artery aneurysms. Long-term follow-up of aneurysmal disease and results of surgical treatment. J Vasc Surg 1991; 13: 398-407
• 49 Jung G, Gkremoutis A, Grundmann R. et al. Poplitealarterienaneurysma: Pathogenese, Klinik und Therapie einer seltenen Entität. Gefässchirurgie 2017; 22: 369-381
• 50 Galland RB. History of the management of popliteal artery aneurysms. Eur J Vasc Endovasc Surg 2008; 35: 466-472
• 51 Ebaugh JL, Morasch MD, Matsumura JS. et al. Fate of excluded popliteal artery aneurysms. J Vasc Surg 2003; 37: 954-959
• 52 Tessarek J. Neue Aspekte der endovaskulären Behandlung des Poplitealaneurysmas: Erste Ergebnisse einer Pilotstudie. Zentralbl Chir 2015; 140: 535-541
• 53 Garg K, Rockman CB, Kim BJ. et al. Outcome of endovascular repair of popliteal artery aneurysm using the Viabahn endoprosthesis. J Vasc Surg 2012; 55: 1647-1653
• 54 Golchehr B, Tielliu IFJ, Verhoeven ELG. et al. Clinical outcome of isolated popliteal artery aneurysms treated with a heparin-bonded stent graft. Eur J Vasc Endovasc Surg 2016; 52: 99-104
• 55 Guzzardi G, Natrella M, Del Sette B. et al. Endovascular repair of popliteal artery aneurysms: an Italian multicenter study. Radiol Med 2019; 124: 79-85
• 56 Thakar T, Chaudhuri A. Early experience with the multilayer aneurysm repair stent in the endovascular treatment of trans/infragenicular popliteal artery aneurysms: a mixed bag. J Endovasc Ther 2013; 20: 381-388
• 57 Ravn H, Wanhainen A, Björck M. Surgical technique and long-term results after popliteal artery aneurysm repair: Results from 717 legs. J Vasc Surg 2007; 46: 236-243
• 58 Huang Y, Gloviczki P, Noel AA. et al. Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: Is exclusion with saphenous vein bypass still the gold standard?. J Vasc Surg 2007; 45: 706-713 discussion 713-715
• 59 Cervin A, Tjörnström J, Ravn H. et al. Treatment of popliteal aneurysm by open and endovascular surgery: a contemporary study of 592 procedures in Sweden. Eur J Vasc Endovasc Surg 2015; 50: 342-350
• 60 Kropman RHJ, van Santvoort HC, Teijink J. et al. The medial versus the posterior approach in the repair of popliteal artery aneurysms: A multicenter case-matched study. J Vasc Surg 2007; 46: 24-30
• 61 Mazzaccaro D, Carmo M, Dallatana R. et al. Comparison of posterior and medial approaches for popliteal artery aneurysms. J Vasc Surg 2015; 62: 1512-1520
• 62 Phair A, Hajibandeh S, Hajibandeh S. et al. Meta-analysis of posterior versus medial approach for popliteal artery aneurysm repair. J Vasc Surg 2016; 64: 1141-1150.e1
• 63 Hogendoorn W, Schlösser FJ, Moll FL. et al. Decision analysis model of open repair versus endovascular treatment in patients with asymptomatic popliteal artery aneurysms. J Vasc Surg 2014; 59: 651-662
• 64 Leake AE, Segal MA, Chaer RA. et al. Meta-analysis of open and endovascular repair of popliteal artery aneurysms. J Vasc Surg 2017; 65: 246-256
• 65 Jung G, Schmitz-Rixen T, Grundmann RT. POPART – ein Register zur Versorgung des Poplitealarterienaneurysmas. Gefässchirurgie 2018; 23: 254-260
• 66 Jung G, Schmitz-Rixen T, Grundmann RT. Was gibt es Neues beim Popliteaaneurysma?. In: Jähne J, Königsrainer A, Schröder W, Südkamp NP. Hrsg. Was gibt es Neues in der Chirurgie? Jahresband 2018. Berichte zur chirurgischen Weiter- und Fortbildung. Heidelberg: ecomed; 2018: 155-162
• 67 Schmitz-Rixen T, Jung G, Steffen M. et al. Registerdaten sind elementar zu den prospektiv randomisierten Studien. Gefässchirurgie 2018; 23: 346-353
• 68 Wooster M, Back M, Gaeto H. et al. Late Longitudinal Comparison of Endovascular and Open Popliteal Aneurysm Repairs. Ann Vasc Surg 2016; 30: 253-257
• 69 Serrano Hernando FJ, Martínez López I, Hernández Mateo MM. et al. Comparison of popliteal artery aneurysm therapies. J Vasc Surg 2015; 61: 655-661
• 70 Del Tatto B, Lejay A, Meteyer V. et al. Open and Endovascular Repair of Popliteal Artery Aneurysms. Ann Vasc Surg 2018; 50: 119-127
• 71 Cronenwett J, Wayne Johnston K. Rutherfordʼs Vascular Surgery. 7th ed. Philadelphia: Saunders; 2010
• 72 Tachtsi MD, Pitoulias GA, Fycatas P. et al. Subclavian artery aneurysm due to clavicle fracture. Ann Vasc Surg 2011; 25: 984.e5-984.e7
• 73 Andersen ND, Barfield ME, Hanna JM. et al. Intrathoracic subclavian artery aneurysm repair in the thoracic endovascular aortic repair era. J Vasc Surg 2013; 57: 915-925
• 74 Polguj M, Chrzanowski Ł, Kasprzak JD. et al. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations – a systematic study of 141 reports. ScientificWorldJournal 2014; 2014: 292734
• 75 Badri H, Bhattacharya V. Diagnosis and Management of thoracic Outlet Syndrome. In: Bhattacharya V, Stansby G. eds. Postgraduate vascular Surgery: The Candidateʼs Guide to the FRCS. Cambridge Medicine; 2011
• 76 Davies AH, Brophy CM. eds. Vascular Surgery. London: Springer; 2006
• 77 Tetik O, Yilik L, Besir Y. et al. Surgical treatment of axillary artery aneurysm. Tex Heart Inst J 2005; 32: 186-188
• 78 Vijayvergiya R, Kumar RM, Ranjit A. et al. Endovascular management of isolated axillary artery aneurysm: a case report. Vasc Endovascular Surg 2005; 39: 199-201
• 79 Tsuda K, Ohkura K, Shintani T. et al. Endovascular treatment of a ruptured innominate artery aneurysm in Behcet disease. Ann Vasc Surg 2016; 33: 230.e1-230.e4
• 80 Antonello M, Frigatti P, Battocchio P. et al. Endovascular treatment of asymptomatic popliteal aneurysms: 8-year concurrent comparison with open repair. J Cardiovasc Surg (Torino) 2007; 48: 267-274
• 81 Kim TI, Sumpio BE. Management of asymptomatic popliteal artery aneurysms. Int J Angiol 2019; 28: 5-10