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Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2015; 02(01): 71-87
DOI: 10.1055/s-0034-1391650
Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Das abdominale Aortenaneurysma

Teil II: Therapie
C.-A. Behrendt
,
H. C. Rieß
,
F. Heidemann
,
T. Kölbel
,
R. T. Grundmann
,
E. S. Debus
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Publikationsverlauf

Publikationsdatum:
17. Februar 2015 (online)

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Fazit

Die Entscheidung zur Therapie des AAA orientiert sich an der Aneurysmagröße und dem Rupturrisiko und sollte das individuelle Operationsrisiko berücksichtigen. Bei asymptomatischen AAA besteht die Indikation zur Operation ab 5,5 cm (Männer), da in dieser Situation das Rupturrisiko das Operationsrisiko übersteigt. Frauen sollten bereits bei Nachweis eines AAA über 5,2 cm gefäßchirurgisch evaluiert werden.

Für die Therapie des AAA stehen konservativ-medikamentöse, offen-chirurgische und endovaskuläre Verfahren teilweise komplementär zur Verfügung; die Therapieplanung sollte interdisziplinär erfolgen und alle Begleitumstände erfassen.

Die Spezialisierung und das Fallaufkommen korrelieren signifikant mit dem Behandlungsergebnis. Die Behandlung komplexer Fälle sollte daher spezialisierten Zentren mit einem hohen Fallaufkommen vorbehalten bleiben.

Die EVAR zeigt gegenüber der OAR periprozedural und im postoperativen Verlauf eine geringere Letalität, die sich nach etwa 2 – 3 Jahren jedoch angleicht.

Vor allem die offene Aortenchirurgie gehört zu den Hochrisikoeingriffen. Zur präoperativen Risikoeinschätzung vor elektiven Aorteneingriffen stehen verschiedene valide Score-Systeme (z. B. BAR-Score) zur Verfügung. Mindestvoraussetzungen an die Anatomie des AAA müssen vor der Entscheidung zur endovaskulären Therapie geprüft werden. Dazu zählen u. a. ein ausreichender Aneurysmahals, ein geeigneter Alpha- und Beta-Winkel sowie die sorgfältige Evaluation der Iliakal- und Zugangsgefäße.

Abweichungen von den Instructions for Use müssen dokumentiert werden.

 

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