Chirurgisches Management des isolierten Beckenarterienaneurysmas

Zusammenfassung

Isolierte Iliakalaneurysmen (IIA) sind zwar selten, stellen aber aufgrund einer beachtlichen Rupturgefahr ein erhöhtes Risiko für den Patienten dar. Ziele dieser Arbeit sind, einen aktuellen Überblick über das chirurgische Behandlungskonzept von IIAs zu geben und eine geeignete Patientenselektion für endovaskuläre Therapieoptionen vorzustellen. Hierzu werden relevante internationale Publikationen und eigene Erfahrungen herangezogen. Die guten Ergebnisse konventioneller Rekonstruktionstechniken bestätigen die offene Operation als derzeitigen Behandlungsstandard. Bei individuell, d. h. patientenbezogenem erhöhtem Operationsrisiko und geeigneter Morphologie können alternativ endovaskuläre Operationstechniken eingesetzt werden. Die internationalen Erfahrungen sind hierzu jedoch wegen geringer Fallzahlen, fehlenden Langzeitergebnissen und noch in Entwicklung befindlicher geeigneter Stentgraftdesigns nur eingeschränkt beurteilbar.

Abstract

Isolated iliac aneurysms (IIA) are uncommon lesions that require surgical repair to prevent rupture. The aim of this article is to give an update on the current surgical management of IIA. This report also evaluates the application of endovascular repair in IIA, based on a recent Pubmed search and on our own experience in the interventional field: Open reconstruction achieves good longterm results and still represents the golden standard in surgical treatment of IIA. Transluminally placed endovascular stent grafts can be successfully used to exclude isolated iliac aneurysms in selected high risk patients with suitable anatomy. A classification based on aneurysm morphology is useful for patient selection. The value of endovascular therapy has yet to be determined.

Schlüsselwörter

Beckenarterie - Iliakalaneurysma - Klassifikation - endovaskulär - Endograft

Key words

iliac artery - aneurysm - classification - endovascular - endograft

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