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Kardiologie up2date 2014; 10(01): 79-89
DOI: 10.1055/s-0034-1365330
Aortenerkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Neue Risikoeinschätzung der Aortendissektion

Falko Tillwich
,
Dimitar Divchev
,
Barbara Richartz
,
Rachel E. Clough
,
Christoph A. Nienaber
Further Information

Publication History

Publication Date:
10 April 2014 (online)

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Abstract

Acute aortic dissection is a multi-facetted disease often associated with fatal outcome. The common denominator of aortic dissection is disruption of the media layer of the aorta with possible complications like sidebranch compromise malperfusion, neurological impairment, pericardial tamponade and cardiogenic shock depending on location and expansion of the dissection. An undelayed diagnostic and therapeutic management are key to successful treatment.

Population-based studies suggest that the incidence of acute dissection ranges from 3 to 4.5 cases per 100 000 person-years. Hypertension, genetic disorders and trauma are the most prevalent risk conditions. Patients with acute aortic dissection often present a with a variety of symptoms with acute chest or back pain as the most commonly presenting symptom, which should rise the awareness for this differential diagnosis. Diagnostics include imaging modalities (such as multislice computed tomography, transoesophageal ultrasound interrogation, or magnetic resonance imaging). Prognosis is clearly related to undelayed and appropriate treatment of Type A and Type B aortic dissection. In case of Type A dissection, surgical repair is required in most instances; conversely, type B dissection is a call for individualized therapeutic approaches favoring endovascular graft-stenting in the presence of complications in addition to blood pressure control, and medical management for uncomplicated cases with an option for preemptive endovascular treatment in most suitable cases. All patients need life-long surveillance regardless of therapy.

Kernaussagen

  • Die Aortendissektion ist ein akutes, lebensbedrohliches Krankheitsbild, das ohne schnelle und gezielte Diagnostik und Therapie eine äußerst ungünstige Prognose hat.

  • Das Hauptsymptom ist der akute Thoraxschmerz. Die klinische Symptomatik kann von neurologischen Symptomen überlagert sein und zu Fehldiagnosen und Zeitverlust führen.

  • Die Diagnostik der Wahl beinhaltet eine frühzeitige, suffiziente Bildgebung. Hierbei stehen CT, TEE und MRT im Vordergrund.

  • Das Spektrum von akuten Komplikationen reicht von Myokardinfarkt, Perikardtamponade und Aortenruptur bis zur klinisch inapparenten Malperfusion von Organen oder Extremitäten.

  • Eine Typ-A-Dissektion wird chirurgisch versorgt.

  • Typ-B-Dissektionen sollten in Abhängigkeit von Risikokonstellationen konservativ, medikamentös oder zusätzlich interventionell mit TEVAR behandelt werden.

  • Das Spektrum der Risikomerkmale einer Typ-B-Dissektion erweitert sich von Zeichen der Organ- und Extremitätenmalperfusion und drohender Ruptur mit Hypotonie und Schockzeichen um persistierende Schmerzsyndrome, refraktäre Hypertonie, frühzeitige klinisch inapparente Expansion des falschen Lumens, großes Entry, Inflammation der dissezierten Aortenwand und partieller Thrombosierung des falschen Lumens.

 

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