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Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2017; 04(01): 41-56
DOI: 10.1055/s-0043-102158
Aorta
© Georg Thieme Verlag KG Stuttgart · New York

Prophylaxe der Rückenmarkischämie bei Therapie von Aortenaneurysmen

Konstantin von Aspern
,
Christian D. Etz
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Publication History

Publication Date:
19 April 2017 (online)

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Die moderne Therapie des thorakoabdominellen Aortenaneurysmas birgt ein immer noch erhebliches Risiko: die iatrogene ischämische Schädigung des Rückenmarks mit der Konsequenz der permanenten Paraplegie. Dieser Beitrag schildert die aktuell verfügbaren unterstützenden Therapiemaßnahmen zur Rückenmarkprotektion und stellt ein neues klinisches Präventionsverfahren vor, das experimentell nahezu 100 %-igen Schutz erzielt hat.
Kernaussagen

  • Sowohl beim chirurgischen Ersatz der thorakoabdominellen Aorta als auch bei TEVAR im Rahmen der Aneurysmatherapie ist das Risiko der ischämischen Rückenmarkschädigung nach wie vor sehr hoch.

  • Mithilfe eines adäquaten peri- und postoperativen Managements, basierend auf dem modernen Konzept der Rückenmarkperfusion, kann dieses Risiko signifikant gesenkt, jedoch bisher nicht eliminiert werden.

  • Die von Etz und Mitarb. kürzlich eingeführte MISACE ist ein katheterbasiertes Verfahren zur Rückenmarkprotektion durch präoperative Konditionierung, das in jedem Katheterlabor unproblematisch durchgeführt werden kann.

  • Sie ist die konsequente Umsetzung des von Etz und Griepp eingeführten Konzepts des Staged Repair.

  • Sie wird als Präventivtherapie zur Prophylaxe des ischämischen Rückenmarkschadens sowohl vor offen-chirurgischer als auch vor endovaskulärer Therapie angewendet.

  • Durch MISACE soll das Risiko der Rückenmarkischämie nach komplexen Rekonstruktionen der thorakoabdominellen Aorta drastisch reduziert, möglicherweise klinisch sogar eliminiert werden.

 

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