Aneurysma der A. profunda femoris – Eine systematische Literaturanalyse

Zusammenfassung

Einleitung: Ein Aneurysma verum der A. profunda femoris (AAPF) ist sehr selten. In den meisten Fällen sind nur Kasuistiken beschrieben. Empfehlungen zur Diagnostik und Therapie des AAPF basieren ausschließlich auf Daten eines niedrigen Evidenzniveaus. Das Ziel dieser Arbeit war eine Zusammenfassung der bisher vorliegenden Erfahrung zum AAPF. Material/Methoden: Aus Anlass eines eigenen Falles wurde eine systematische Literaturanalyse zur Diagnostik und Therapie des echten AAPF vorgenommen. Die Literaturrecherche erfolgte in PubMed, EMBASE und in der Cochrane-Datenbank sowie durch eine Handsuche nach Auswertung der Literaturverzeichnisse der einzelnen Publikationen. Ergebnisse: Es wurden 25 Publikationen über echte AAPF nach 2002 veröffentlicht. Neben 2 retrospektiven Studien über einen längeren Zeitraum handelte es sich ausschließlich um Kasuistiken. In diesen Arbeiten wurde über insgesamt 55 AAPF verum berichtet bei 47 Patienten mit einem mittleren Alter von 63 Jahren. Die Therapie erfolgte aufgrund einer Ruptur in 10 Fällen (18 %). Der Maximaldurchmesser des AAPF bei klinischer Vorstellung der Patienten betrug im Durchschnitt 5,4 cm (2–18 cm). Bei nicht rupturiertem AAPF bestand eine Symptomatik in den meisten Fällen in Form einer schmerzhaften pulsierenden Schwellung in der Leistenregion und am Oberschenkel. Die Ausschaltung des AAPF erfolgte konventionell über einen offenen Zugang oder endovaskulär, mit oder ohne Revaskularisation der A. profunda femoris. Diskussion: Bei der klinischen Symptomatik einer Schwellung und Schmerzen infrainguinal am proximalen Oberschenkel sollte ein AAPF in die Differenzialdiagnose einbezogen werden. Die gefäßchirurgische Therapie zur Aneurysmaausschaltung ist elektiv bei einem Maximaldurchmesser von mehr als 2 cm oder Größenprogredienz und in jedem Fall bei Symptomatik oder Ruptur indiziert. Die Möglichkeiten einer endovaskulären Therapie sollten in jedem Fall in Betracht gezogen werden.

Abstract

Introduction: True aneurysms of the deep femoral artery (APFA) are rare and are usually presented as case reports. Recommendations for diagnostics and therapy of APFAs are based on low-level evidence only. The purpose of this paper was to summarise the existing world experience with APFA. Material/Methods: On the occasion of our own case a systematic review of the literature was performed for diagnostics and therapy for true APFA. Publications retrieved from PubMed, EMBASE, and the Cochrane Collaboration as well as by hand search from their references were reviewed. Results: From 2002 onwards 25 papers on true APFAs were published in the English and German literature. Apart from two retrospective studies over a longer period of time these were exclusively case reports. A total of 55 true APFAs were reported in 47 patients with a mean age of 63 years. Therapeutic intervention was due to a rupture in 10 cases (18 %). The mean maximal diameter of APFA at presentation was 5.4 cm (2–18 cm). APFAs that were not ruptured presented frequently as a painful pulsatile mass in the groin and thigh. Therapeutic options for APFA included, apart from surgical resection with or without reconstruction of the deep femoral artery, the endovascular repair. Discussion: Symptoms of swelling and pain in the presence of a mass at the proximal thigh should raise the suspicion of an APFA. Surgical therapy should be performed electively in APFAs with a diameter of more than 2 cm or in cases of rapid progression as well as in all symptomatic or ruptured cases. The endovascular approach should be considered as an alternative option in all cases.

Schlüsselwörter

Aneurysma - A. profunda femoris - echtes Aneurysma - A. femoralis

Key words

aneurysms - deep femoral artery - true aneurysms - femoral artery

Beide Autoren haben zu gleichen Teilen zum Entstehen der Arbeit beigetragen.

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