Malperfusion nach Aortendissektion - Management und Techniken

Zusammenfassung

Malperfusion stellt eine häufige Komplikation der Aortendissektion dar und erhöht die Letalität dieser tödlichen Erkrankung weiter. Eine effektive Behandlungsstrategie erfordert eine zeitnahe Diagnose anhand der Klinik und der verfügbaren Instrumente, das Verständnis des Pathomechanismus der Erkrankung und das Erkennen der leitliniengerecht empfohlenen Therapieoptionen sowie der diagnostischen und therapeutischen Innovationen des Forschungsgebiets. Die letztendliche Therapieentscheidung soll patienten- bzw. fallspezifisch gefällt werden. In dieser Arbeit haben wir die Malperfusion nach Aortendissektion nicht nur als Komplikation der Aortendissektion, sondern als eigenständiges Krankheitsbild betrachtet und wichtige Informationen zusammengefasst, die zu effizienten Therapieentscheidungen im klinischen Alltag beitragen können.

Abstract

Malperfusion is a common complication of aortic dissection and further increases this deadly disease’s mortality. An effective treatment strategy requires a timely diagnosis based on the clinical findings and the available instruments, understanding the disease’s pathomechanism, recognising the therapy options recommended by the guidelines, and the diagnostic and therapeutic innovations of the area of research. The final treatment decision should be patient- and case-specific. In this work, we have considered malperfusion after aortic dissection, not only as a complication of aortic dissection but as a separate disease and summarise important information that can contribute to efficient therapy decisions in everyday clinical practice.

Schlüsselwörter

Aortenchirurgie - Aortenstentprothese - Aortendissektion - Malperfusion - TEVAR

Keywords

aortic surgery - aortic stent prosthesis - aortic dissection - Malperfusion - TEVAR

• Literatur

• 1 Norton EL, Williams DM, Kim KM. et al. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg 2020; 160: 1151-1161.e1
• 2 Norton EL, Khaja MS, Williams DM. et al. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol 2019; 34: 610-615
• 3 Tsilimparis N, Spath P. Malperfusion in aortic dissections: a game of pressures we need to understand better. J Cardiovasc Surg (Torino) 2022; 63: 115-116
• 4 Tsilimparis N, Prendes CF, Heidemann F. et al. Impact of true or false lumen renal perfusion after type B aortic dissection on renal volume. J Cardiovasc Surg (Torino) 2022; 63: 124-130
• 5 Yang B, Patel HJ, Williams DM. et al. Management of type A dissection with malperfusion. Ann Cardiothorac Surg 2016; 5: 265-274
• 6 Crawford TC, Beaulieu RJ, Ehlert BA. et al. Malperfusion syndromes in aortic dissections. Vasc Med 2016; 21: 264-273
• 7 Slonim SM, Miller DC, Mitchell RS. et al. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 1999; 117: 1118-1126
• 8 Williams DM, Lee DY, Hamilton BH. et al. The dissected aorta: percutaneous treatment of ischemic complications--principles and results. J Vasc Interv Radiol 1997; 8: 605-625
• 9 Grewal S, Contrella BN, Sherk WM. et al. Endovascular Management of Malperfusion Syndromes in Aortic Dissection. Tech Vasc Interv Radiol 2021; 24: 100751
• 10 Barnes DM, Williams DM, Dasika NL. et al. A single-center experience treating renal malperfusion after aortic dissection with central aortic fenestration and renal artery stenting. J Vasc Surg 2008; 47: 903-910
• 11 Lombardi JV, Hughes GC, Appoo JJ. et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg 2020; 71: 723-747
• 12 Saha S, Fabry TG, Buech J. et al. Time is of the essence: where can we improve care in acute aortic dissection?. Interact Cardiovasc Thorac Surg 2021; 33: 941-948
• 13 Erbel R, Aboyans V, Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2873-2926
• 14 Patel HJ, Williams DM, Dasika NL. et al. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg 2008; 135: 1288-1295
• 15 Deeb GM, Patel HJ, Williams DM. Treatment for malperfusion syndrome in acute type A and B aortic dissection: A long-term analysis. J Thorac Cardiovasc Surg 2010; 140 (Suppl. 06) S98-S100
• 16 Piccardo A, Regesta T, Zannis K. et al. Outcomes after surgical treatment for type A acute aortic dissection in octogenarians: a multicenter study. Ann Thorac Surg 2009; 88: 491-497
• 17 Estrera AL, Miller CC, Kaneko T. et al. Outcomes of acute type a aortic dissection after previous cardiac surgery. Ann Thorac Surg 2010; 89: 1467-1474
• 18 Law Y, Kölbel T, Detter C. et al. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Ann Thorac Surg 2019; 107: 1799-1806
• 19 Bosse C, Kölbel T, Mougin J. et al. Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch. J Vasc Surg 2020; 72: 805-811
• 20 Law Y, Tsilimparis N, Rohlffs F. et al. Combined Ascending Aortic Stent-Graft and Inner Branched Arch Device for Type A Aortic Dissection. J Endovasc Ther 2018; 25: 561-565
• 21 Tsilimparis N, Drewitz S, Detter C. et al. Endovascular Repair of Ascending Aortic Pathologies With Tubular Endografts: A Single-Center Experience. J Endovasc Ther 2019; 26: 439-445
• 22 Riambau V, Böckler D, Brunkwall J. et al. Editor’s Choice – Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 53: 4-52
• 23 Nienaber CA, Kische S, Zeller T. et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J Endovasc Ther 2006; 13: 738-746
• 24 Lombardi JV, Cambria RP, Nienaber CA. et al. Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J Vasc Surg 2014; 59: 1544-1554
• 25 Lombardi JV, Cambria RP, Nienaber CA. et al. Five-year results from the Study of Thoracic Aortic Type B Dissection Using Endoluminal Repair (STABLE I) study of endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2019; 70: 1072-1081.e2
• 26 Hofferberth SC, Nixon IK, Boston RC. et al. Stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair: the STABILISE concept. J Thorac Cardiovasc Surg 2014; 147: 1240-1245
• 27 Melissano G, Bertoglio L, Rinaldi E. et al. Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection. J Vasc Surg 2018; 68: 966-975