Stellenwert der „inner Branches“ in der komplexen endovaskulären Aortenchirurgie

Zusammenfassung

Die komplexe endovaskuläre Therapie der Aorta mit fenestrierten und gebranchten Prothesen spielt eine wichtige Rolle in der heutigen Gefäßmedizin. Daraus resultieren innovative medizintechnische Lösungen, die für immer anspruchsvollere Aortenpathologien eingesetzt werden. Das Ziel dieser Arbeit war es, die zunehmende Bedeutung der „inner Branches“ in der komplexen Aortenchirurgie darzustellen. Die Vorteile und Grenzen dieser Technik sollten aufgezeigt und die aktuelle Datenlage zusammengefasst werden. Dazu wurden die „inner Branches“ (iBEVAR) den Standardverfahren (Fenestrationen [FEVAR], „outer Branches“ [BEVAR]) gegenübergestellt und ihre technischen Vor- und Nachteile erarbeitet. Kennzeichnend ist der weit verbreitete Einsatz der iBEVAR im Aortenbogen im Gegensatz zur thorakoabdominellen Aorta, was sich auch in der spärlichen Datenlage im thorakoabdominellen Abschnitt widerspiegelt. Die Letztere basiert auf kleineren retrospektiven Studien mit 1-jährigem Follow-up. Die seit 2 Jahren verfügbare thorakoabdominelle „off-the-shelf“-Prothese wird voraussichtlich zu einer weiteren Verbreitung der „inner Branches“ im thorakoabdominellen Abschnitt führen, wobei die von der Industrie geförderte Registerstudie wichtige Evidenz zur erörterten Technik bereitstellen könnte.

Abstract

Complex endovascular therapy of the aorta with fenestrated and branched endografts plays an essential role in modern vascular medicine. Innovative solutions for demanding aortic pathologies are therefore being constantly developed by the medical industry. The aim of this manuscript is to illustrate the growing importance of the inner branches in complex aortic repair and to show the advantages and limits of this technique with an overview of the current literature. The inner branches (iBEVAR) were therefore compared to the standard treatment options (fenestrations; [FEVAR], outer branches [BEVAR]) and the technical advantages of all platforms were evaluated. The widespread use of iBEVAR in the aortic arch stands in contrast to the thoracoabdominal aorta, which is mirrored by the scarce evidence for the thoracoabdominal inner branches. The published experience is based on smaller retrospective studies with a 1-year follow-up. The E-nside (Artivion, Hechingen, Germany) thoracoabdominal off-the-shelf inner-branch-based endograft was released 2 years ago. Its widespread deployment may increase the use of the inner branches in the thoracoabdominal aorta. Moreover, an ongoing industry-funded registry may provide new insights into the long-term durability of this innovative technique.

Schlüsselwörter

Stentprothese - Aortenchirurgie - Aortenaneurysma - endovaskuläre Therapie - Aortenstentprothese

Keywords

stent prosthesis - endovascular treatment - aortic aneurysm - aortic stent prosthesis - aortic surgery

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