Neue Aspekte der endovaskulären Behandlung des Poplitealaneurysmas: Erste Ergebnisse einer Pilotstudie

Zusammenfassung

Das Popliteaaneurysma ist das häufigste periphere Aneurysma und imponiert klinisch meist mit Symptomen einer peripheren Verschlusskrankheit, einer akuten Embolisation oder Thrombose. Die Ruptur ist ein extrem seltenes Ereignis. Aufgrund des hohen Risikos des Extremitätenverlusts sollte die Behandlung frühzeitig erfolgen. Neben den gängigen Bypassverfahren haben sich die endovaskulären Optionen in den vergangenen Jahren weiterentwickelt, die Entscheidung für den Einsatz gecoverter Stents basiert jedoch auf wenigen, teils widersprüchlichen Daten und die Systeme unterliegen erheblichen Limitierungen bei gleichzeitig hohen Kosten. Eine Alternative zum gecoverten Stent ist der Flowdiverter, hier in Form eines 2-lagig implantierten Bare Metal Stents mit für die A. poplitea optimalen Materialeigenschaften. Die vorliegenden Ergebnisse dieser Pilotstudie mit 13 Aneurysmen zeigen im Follow-up von 2 bis 23 Monaten vielversprechende Ergebnisse ohne perioperative Komplikationen, Stentfrakturen, Migration oder Separation von Stentanteilen bei 100 % technischem Erfolg mit kompletter Thrombosierung der Aneurysmen und deutlich geringeren Kosten als gecoverte Stents. Die Reverschlussrate lag, wie zu erwarten, bei den elektiv operierten Patienten deutlich niedriger als bei einer Primärintervention im akuten Verschlussstadium mit Aspirationsthrombektomie und adjuvanter Thrombolyse. Die erreichten Ergebnisse erlauben es, das Prinzip der kompletten Aneurysmaausschaltung durch Bypass oder gecoverte Stents infrage zu stellen.

Abstract

Popliteal aneurysms are the most often diagnosed peripheral aneurysms and are often associated with chronic occlusive disease or acute thrombosis with limb-threatening critical ischaemia. Rupture is a rare event. Due to the immense risk of limb loss, early treatment in the asymptomatic stage is recommended either with surgical bypass, interposition or endovascular means using covered stents. Published data are inconclusive concerning endovascular treatment and implant costs are high. An alternative strategy consists in using flow diverters with optimal material characteristics for use in the popliteal artery, in our study this is represented by a woven nitinol bare metal stent with extreme flexibility and high radial force resistance. In this pilot study 13 aneurysms were treated successfully with promising results after 2 to 23 months follow-up. Technical success was achieved in 100 % with complete aneurysm thrombosis and no perioperative complications such as stent fractures, device migration or separation could be detected. Implant costs were significantly lower compared to those for covered stents. The re-occlusion rate was lower for electively treated patients compared to aneurysms treated in an acute stadium of thrombosis treated with rotational aspiration and thrombolysis. The given results allow us to query the need for complete aneurysm exclusion with covered stents or bypasses.

Schlüsselwörter

Popliteaaneurysma - Superastent® - Flussmodulation - laminarer Fluss - Risikoreduktion

Key words

popliteal aneurysm - Superastent® - flow modulation - laminar flow - risk reduction

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