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 zeichnen 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:
21 October 2021

• Literatur

• 1 Lakin RO, Kashyap VS. Splanchnic Artery Aneurysms. In: Cronenwett JL, Johnston KW. eds. Rutherfordʼs vascular Surgery. 8th ed. Philadelphia: Saunders/Elsevier; 2014: 2220-2222
• 2 Jesinger AR, Thoreson AA, Lamba R. Abdominal and pelvic aneurysms and pseudoaneurysms: imaging review with clinical, radiologic, and treatment correlation. Radiographics 2013; 33: E71-E96
• 3 Hemp JH, Sabri SS. Endovascular management of visceral arterial aneurysms. Tech Vasc Interv Radiol 2015; 18: 14-23
• 4 van Rijn MJE, Ten Raa S, Hendriks JM. et al. Visceral aneurysms: old paradigms, new insights?. Best Pract Res Clin Gastroenterol 2017; 31: 97-104
• 5 Corey MR, Ergul EA, Cambria RP. et al. The natural history of splanchnic artery aneurysms and outcomes after operative intervention. J Vasc Surg 2016; 63: 949-957
• 6 Ferrero E, Gaggiano A, Ferri M. et al. Visceral artery aneurysms: series of 17 cases treated in a single center. Int Angiol 2010; 29: 30-36
• 7 Pulli R, Dorigo W, Troisi N. et al. Surgical treatment of visceral artery aneurysms: a 25-year experience. J Vasc Surg 2008; 48: 334-342
• 8 Cordova AC, Sumpio BE. Visceral artery aneurysms and pseudoaneurysms – should they all be managed by endovascular techniques?. Ann Vasc Dis 2013; 6: 687-693
• 9 Abbas MA, Fowl RJ, Stone WM. et al. Hepatic artery aneurysm: Factors that predict complications. J Vasc Surg 2003; 38: 41-45
• 10 Stone WM, Abbas M, Cherry KJ. et al. Superior mesenteric artery aneurysms: is presence an indication for intervention?. J Vasc Surg 2002; 36: 234-237
• 11 Nosher JL, Chung J, Brevetti LS. et al. Visceral and renal artery aneurysms: a pictorial essay on endovascular therapy. Radiographics 2006; 26: 1687-1704
• 12 Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg 2005; 18: 196-201
• 13 Sachdev-Ost U. Visceral artery aneurysms: review of current management options. Mt Sinai J Med 2010; 77: 296-303
• 14 Rajah G, Narajanan S, Rangel-Castilla S. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2017; 42: E2
• 15 Akkan K, Elgit E, Karaman K. et al. The new double-layer micromesh stent (Roadsaver^®): use in endovascular treatment of supraaortic and visceral artery aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol 2017; 40: 1338-1343
• 16 Sfyroeras G, Dalainas I, Giannakopoulos TG. et al. Flow-diverting stents for the treatment of arterial aneurysms. J Vasc Surg 2012; 56: 839-846
• 17 Gabelmann A, Görich J, Merkle EM. Endovascular treatment of visceral artery aneurysms. J Endovasc Ther 2002; 9: 38-47
• 18 Hossain A, Reis ED, Dave SP. et al. Visceral artery aneurysms: experience in a tertiary-care center. Am Surg 2001; 67: 432-437
• 19 Carr SC, Mahvi DM, Hoch JR. et al. Visceral artery aneurysm rupture. J Vasc Surg 2001; 33: 806-811
• 20 Tulsyan N, Kashyap VS, Greenberg RK. et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2007; 45: 276-283
• 21 Chiesa R, Astore D, Guzzo M. et al. Visceral artery aneurysms. Ann Vasc Surg 2005; 19: 42-48
• 22 Abbas MA, Stone WM, Fowl RJ. et al. Splenic artery aneurysms: two decades experience at Mayo clinic. Ann Vasc Surg 2002; 16: 442-449
• 23 Pitton MB, Dappa E, Jungmann F. et al. Visceral artery aneurysms: incidence, management, and outcome analysis in a tertiary care center over one decade. Eur Radiol 2015; 25: 2004-2014
• 24 Kasirajan K, Greenberg RK, Clair D. et al. Endovascular management of visceral artery aneurysm. J Endovasc Ther 2001; 8: 150-155
• 25 Cochennec F, Riga CV, Allaire E. et al. Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers. Eur J Vasc Endovasc Surg 2011; 42: 340-346
• 26 Roberts KJ, McCulloch N, Forde C. et al. Emergency treatment haemorrhaging coeliac or mesenteric artery aneurysms and pseudoaneurysms in the era of endovascular management. Eur J Vasc Endovasc Surg 2015; 49: 382-389
• 27 Carroccio A, Jacobs TS, Faries P. et al. Endovascular treatment of visceral artery aneurysms. Vasc Endovascular Surg 2007; 41: 373-382
• 28 Etezadi V, Gandhi RT, Benenati JF. et al. Endovascular treatment of visceral and renal artery aneurysms. J Vasc Interv Radiol 2011; 22: 1246-1253
• 29 Dorigo W, Pulli R, Azas L. et al. Early and intermediate results of elective endovascular treatment of true visceral artery aneurysms. Ann Vasc Surg 2016; 30: 211-218
• 30 Marone EM, Mascia D, Kahlberg A. et al. Is open repair still the gold standard in visceral artery aneurysm management?. Ann Vasc Surg 2001; 25: 936-946
• 31 Frankhauser GT, Stone WM, Naidu SG. et al. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2011; 53: 966-970
• 32 Boos J, Fang J, Heidinger BH. et al. Dual energy CT angiography: pros and cons of dual-energy metal artifact reduction algorithm in patients after endovascular aortic repair. Abdom Radiol (NY) 2017; 42: 749-758
• 33 Winklhofer S, Hinzpeter R, Stocker D. et al. Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy. Neuroradiology 2018; 60: 281-291
• 34 Chisci E, Harris L, Guidotti A. et al. Endovascular aortic repair follow up protocol based on contrast enhanced ultrasound is safe and effective. Eur J Vasc Endovasc Surg 2018; 56: 40-47
• 35 Partovi S, Trischman T, Rafailidis V. et al. Multimodality imaging assessment of endoleaks post-endovascular aortic repair. Br J Radiol 2018; 91: 20180013
• 36 Rübenthaler J, Zimmermann H, Armbruster M. et al. Contrast-enhanced ultrasound in the follow-up of endoleaks after endovascular aortic repair (EVAR). Ultraschall Med 2017; 38: 244-264
• 37 Pfister K, Kasprzak PM, Jung EM. et al. Contrast-enhanced ultrasound to evaluate organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms. Clin Hemorheol Microcirc 2016; 64: 689-698
• 38 Chiardia M, Novelli L, Deux JF. et al. Ruptured visceral artery aneurysms. Diagn Interv Imaging 2015; 96: 797-806
• 39 Hagspiel KD, Flors L, Hanley M. et al. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol 2015; 18: 2-13
• 40 Koganemaru M, Abe T, Nonoshita M. et al. Follow-up of true visceral artery aneurysm after coil embolization by three dimensional contrast-enhanced MR angiography. Diagn Interv Radiol 2014; 20: 129-135
• 41 Lagana D, Carrafiello G, Mangini M. et al. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms. Eur J Radiol 2006; 59: 104-111
• 42 Ferrero E, Ferro M, Viazzo A. et al. Visceral artery aneurysms, an experience on 32 cases in a single centre: treatment from surgery to multilayer stent. Ann Vasc Surg 2011; 25: 923-935