Therapie primärer Aneurysmen der Extremitätenarterien

Zusammenfassung

Periphere arterielle Aneurysmen sind seltene Gefäßerkrankungen, bei denen das betroffene Gefäßsegment auf mindestens das 1,5-Fache des nativen Gefäßdurchmessers dilatiert ist. Grundsätzlich können primäre Aneurysmen an sämtlichen Gefäßen auftreten. Die diagnostischen Verfahren umfassen neben der Duplexsonografie die CT- und MR-Angiografie sowie die digitale Subtraktionsangiografie. Von essenzieller Bedeutung ist es, im Rahmen der Diagnostik die Morphologie des Aneurysmas und die Zu- und Abstromverhältnisse möglichst exakt abzubilden. Die häufigste Entität peripherer Aneurysmen sind Poplitealarterienaneurysmen, die eine hohe Koinzidenz mit Aortenaneurysmen haben. Im Rahmen von Bindegewebserkrankungen oder Autoimmunerkrankungen können periphere arterielle Aneurysmen gehäuft auftreten (Ehlers-Danlos-Syndrom, Marfan-Syndrom, Morbus Behçet). Therapeutisch stehen als aktueller Therapiestandard offen chirurgische Verfahren zur Verfügung, aber auch endovaskuläre Therapieansätze sind beschrieben. Aktuell bietet die Literatur aufgrund der Seltenheit der Erkrankungen keine gute Evidenz zum Vergleich beider Verfahren. Für das Poplitealarterienaneurysma zeichnet sich aufgrund von mehreren Registerstudien und Singlecenterstudien ab, dass bei strenger Patientenselektion die endovaskuläre Therapie ein vergleichbares Outcome zur offenen Therapie bieten kann, wenngleich offene Chirurgie therapeutischer Standard bleibt. Für die Therapieplanung arterieller Aneurysmen an den Extremitäten müssen insbesondere individuelle Behandlungskriterien wie die Morphologie des Aneurysmas, die anatomische Lokalisation, besonders in Bezug auf bewegliche Segmente, der Gefäßabstrom und der Allgemeinzustand des Patienten berücksichtigt werden.

Abstract

Peripheral arterial aneurysms are rare vascular pathologies characterised by focal dilatation of at least 1.5-fold relative to the diameter of the native vessel. Primary arterial aneurysms can affect any segment of the arterial trunk. Diagnostic tests include duplex sonography, CT and MR angiography, and digital subtraction angiography. It is essential that the influx and efflux to the aneurysm should be mapped as precisely as possible. The most common type of peripheral arterial aneurysms are popliteal artery aneurysms, which frequently occur with aorta aneurysms. Peripheral arterial aneurysms are more common in patients with connective tissue disease or autoimmune disease (Ehlers-Danlos syndrome, Marfan syndrome, Behçetʼs disease). The current gold standard for therapy is surgery, although endovascular therapies have also been described. As the condition is rare, there is insufficient evidence to compare these approaches. Results from several register studies and single centre studies in patients with popliteal aneurysms indicate that endovascular therapy can give similar outcomes to open therapy if patients are carefully selected. Nevertheless, open surgery remains the gold standard. Therapy of aneurysms of the extremities must consider individual treatment criteria, such as the morphology of the aneurysm, its anatomical localisation – particularly with respect to mobilise segments, vascular efflux and the patientʼs general condition.

Schlüsselwörter

Gefäßchirurgie - periphere Aneurysmen - Poplitealarterienaneurysma - endovaskulär

Key words

peripheral aneurysm - vascular surgery - popliteal artery aneurysm - endovascular

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