Thorakale Aortenstents

Zusammenfassung

Ziel: Darstellung der sinnvollen Indikationen für eine interventionelle Aortenstentgraftimplantation zur Erreichung guter Akut- und Langzeitergebnisse. Patienten, Material und Methode: Daten von 51 Patienten mit thorakalen Aortenaneurysmata, Typ B Dissektionen, gedeckten Perforationen und einer aorto-bronchialen Fistel, die zur interventionellen thorakalen Aortenstentimplantation vorgestellt worden waren, wurden ausgewertet. Alle Patienten wurden interdisziplinär mit der thoraxchirurgischen und radiologischen Klinik besprochen. 20 Patienten wurden primär chirurgisch und 31 primär interventionell behandelt. Bei allen wurde eine Multidetektor-CT-Angiographie durchgeführt. Die Stentgraftimplantation erfolgte in einer DSA-Angiographieeinheit unter Vollnarkose, wobei 29 Patienten eine Talent LPS™- und 4 eine Excluder™-Endoprothese implantiert bekamen. Ergebnisse: 29 Patienten hatten Aneurysmata im Bereich der deszendierenden thorakalen Aorta, 21 Patienten eine Typ-B-Dissektion, 19 eine gedeckte Perforation und 1 Patient eine aortobronchiale Fistel. Der Follow-up-Zeitraum betrug 13,4 Monate. Bei 29 Patienten war die Stentgraftimplantation erfolgreich, bei 2 Patienten ließ sich die Prothese wegen massiver iliakaler Gefäßkinckings und -verkalkungen nicht in die Aorta vorschieben. Bei einem Patienten trat eine iliakale Dissektion auf, die in gleicher Sitzung operativ behandelt wurde. In 2 Fällen zeigte sich in der Kontrolle ein Endoleak, das erfolgreich in einer zweiten Intervention verschlossen wurde. Ein Patient verstarb periinterventionell. Neurologische Komplikationen traten nicht auf. Schlussfolgerung: Die perkutane Behandlung von Läsionen der deszendierenden thorakalen Aorta mittels Stentgraftimplantation ist eine sichere, erfolgversprechende Alternative zur chirurgischen Therapie. Vor Intervention ist eine Multidetektor-CT-Angiographie erforderlich, um die Möglichkeit einer endoluminalen Therapieoption zu prüfen und die Intervention exakt zu planen.

Summary

Aim: Determination of the conditions for good acute and long term results of interventional therapy of lesions of the thoracic aorta using stent-grafts. Patients, material and methods: 51 patients with aneurysm of the thoracic aorta (type B dissections) covered rupture and aortobronchial fistula were evaluated. All cases were discussed in an interdisciplinary conference consisting of thoracic surgeon and interventional radiologist. Primarily, 20 patients were operated and 31 were treated by intervention. For all a multidetector row CT angiography was ordered prior to the discussion. All procedures were performed in a DSA suite under general anaesthesia. In 29 patients Talent LPS™ tube grafts and in four patients an Excluder™ graft was implanted. Results: 29 patients had an aneurysm of the thoracic aorta, 21 a type B dissection, 19 a perforation and one patient had an aortobronchial fistula. The follow up was 13.4 months. In 29 patients the stent-graft implantation was successful, in 2 patients stent-graft delivery failed due to severe calcification and kincking of both common iliac arteries. One patient had an iliacal dissection after stentgraft delivery which was treated successfully by surgery. In two patients CT angiographic control detected endoleaks, which were treated with a second stent-graft placement. One patient with an acute perforation of the descending aorta died due to cardiac failure prior to stent-graft implantation. Any neurological complication did not occur. Conclusion: Percutaneous treatment of lesions of the descending thoracic aorta using stent-grafts is a safe and feasible alternative treatment to surgical repair. Prior to the intervention a multidetector row CT angiography is necessary for exact planning of the endoluminal treatment.

Schlüsselwörter

Thorakale Aorta - endoluminale Therapie - Stentgraft - Aortenaneurysma - Aortendissektion

Keywords

Toracic aorta - endoluminal treatment - stentgraft - aortic aneurysm - aortic dissection

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