Endovaskuläre Therapie von Viszeralarterienaneurysmata – geht das immer?

Die endovaskuläre Versorgung von viszeralen Aneurysmata sowie von Pseudoaneurysmata stellt eine interventionelle Alternativmethode zur operativen Therapie dar, die in vielen Zentren inzwischen als Methode der 1. Wahl gilt. Das Verfahren zeichnet sich durch eine hohe technische Erfolgsrate bei niedriger Komplikationsrate aus. Der Artikel stellt die Grundprinzipien der endovaskulären Versorgung dar und diskutiert Stellenwert und Limitierungen des Verfahrens.

Kernaussagen

• Echte Viszeralarterienaneurysmata (VAA) und Viszeralarterienpseudoaneurysmata (VAPA) treten auf im Stromgebiet von

  • Truncus coeliacus,

  • A. mesenterica superior,

  • A. mesenterica inferior

• Neben der operativen Therapie stellt die endovaskuläre Versorgung viszeraler Aneurysmata sowie Pseudoaneurysmata eine interventionelle Alternativmethode dar, die sich in den letzten beiden Dekaden sprunghaft entwickelt hat und in vielen Zentren als Methode der 1. Wahl gilt.

• Die endovaskulären Verfahren zeichnet sich durch eine hohe technische Erfolgsrate bei niedriger Komplikationsrate aus.

• Zu den Limitationen der endovaskulären Versorgung von VAA und VAPA gehören u. a.

  • fehlender transvaskulärer Zugang,

  • ungeeignete Lokalisation des Aneurysmas,

  • Zielgefäß zu fein.

• Nur in spezialisierten Gefäßzentren lassen sich interdisziplinär die Herausforderungen bewältigen, die VAA/VAPA mit sich bringen und somit das notwendige Komplikationsmanagement gewährleisten.

Schlüsselwörter

Aneurysma - endovaskuläre Therapie - Viszeralarterien

Publication History

Article published online:
26 February 2020

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