Endovaskuläre Therapie des Bauchaortenaneurysmas: Prä- und postinterventionelle bildgebende Diagnostik

Zusammenfassung

Der radiologischen Bildgebung kommt eine entscheidende Rolle in der morphologischen Beurteilung infrarenaler Aortenaneurysmata, der Selektion der für eine interventionelle Therapie geeigneten Patienten und der Nachsorge nach erfolgter Stentgraftimplantation zu. Dabei werden vor allem Schnittbildverfahren wie die Computertomografie (CT) und die Magnetresonanztomografie (MRT) eingesetzt, die eine exakte Darstellung der Bauchaorta und ihrer Äste ermöglichen. Darüber hinaus ist mit der Hilfe von 3D-Nachverarbeitungsverfahren auch eine präzise Vermessung der Aneurysmata möglich. Präinterventionell gilt das Augenmerk vor allem der proximalen und distalen Verankerungszone und der Beurteilung des Zugangsweges über die Beckenarterien. In der Nachsorge müssen etwaige Endoleckagen sowie eine weitere Größenzunahme des Aneurysmas zuverlässig erkannt werden. Daneben sind die Beurteilung der Integrität des Stentmaterials sowie der Ausschluss einer Stentgraftmigration bzw. Stentgraftthrombose von Bedeutung. In dieser Übersicht werden die Vor- und Nachteile der einzelnen bildgebenden Verfahren in der prä- und postinterventionellen Bildgebung beleuchtet. Daneben sollen die wichtigsten Kriterien für eine erfolgreiche Aneurysmaaussschaltung und die Nachsorge dargestellt werden.

Abstract

Imaging plays an important role in the selection of patients with infrarenal aortic aneurysms suitable for interventional therapy and preinterventional workup. It is also an important tool for follow-up after stentgraft placement. Cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) allow the delineation of the vessel lumen and sidebranches. Modern postprocessing techniques permit precise measurement of aneurysm properties such as the length and diameter of the proximal and distal neck and the length and diameter of the aneurysm. Evaluation of the access vessel is also possible. During follow-up after stentgraft placement, it is important to detect possible endoleaks and further growth of the aneurysm sac. Furthermore fractures of the stent struts, migration of the stent, and instent thrombosis must to be detected. This review provides an overview of the pros and cons of the different imaging modalities in pre- and postinterventional studies. In addition the most important criteria for the exclusion of infrarenal aortic aneurysms and for patient follow-up are presented.

Key words

aorta - angiography - stents - CT angiography - MR imaging

Literatur

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