Behandlung von Aneurysmen und Dissektionen der thorakalen Aorta

Zusammenfassung

Die wichtigsten Erkrankungen der thorakalen Aorta sind das Aneurysma und die Dissektion in ihrer akuten oder chronischen Form. Überschreitet der Aortendurchmesser bei Aneurysma oder chronischer Dissektion bestimmte Schwellenwerte (oder liegt eine prognostisch relevante Aortenklappeninsuffizienz vor), so besteht eine Behandlungsnotwendigkeit. Die traditionelle chirurgische Therapie in Form des Aortenersatzes ist bei den meisten Patienten heute mit geringen Risiken verbunden. Bei der proximalen Aorta bietet sich in vielen Fällen die Möglichkeit des Klappenerhalts mit einem geringeren Risiko klappenassoziierter Komplikationen als nach Klappenersatz. Bei der distalen Aorta besteht die interventionelle Möglichkeit der Stentgraft-Behandlung, deren genaue Bedeutung in Bezug auf Indikationen und Langzeitresultate noch bestimmt werden muss.

Abstract

The most important diseases of the thoracic aorta are aortic aneurysm and dissection, either in its acute or chronic form. Once aortic diameter exceeds specific values (or prognostically relevant aortic regurgitation is present) treatment is warranted for aneurysm or chronic dissection. Traditional surgical treatment, i.e. aortic replacement, currently carries a low risk. In the context of proximal aortic replacement the native aortic valve can be spared with a risk of valve-related complications that is lower than that after valve replacement. In treating diseases of the distal aorta stent graft placement is an interventional option; its exact role regarding indications and long-term results still needs to be defined.

Schlüsselwörter

Ascendens-Aneurysma - Aortenbogenaneurysma - Descendens-Aneurysma - Aortenklappeninsuffizienz - akute Dissektion - chronische Dissektion

Key words

ascending aortic aneurysm - arch aneurysm - descending aortic aneurysm - aortic regurgitation - acute aortic dissection - chronic aortic dissection

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