Aneurysmen und Pseudoaneurysmen viszeraler Arterien – interventionelle Therapie

Aneurysmen der Viszeralarterien sind zumeist asymptomatisch, können jedoch im Rahmen einer Ruptur lebensbedrohlich und akut interventionsbedürftig werden. Der vorliegende Beitrag führt deshalb eine Evaluation der Erfahrungen in der interventionellen endovaskulären Therapie von inzidentellen und symptomatischen Aneurysmen der viszeralen Gefäße in der elektiven sowie der Notfallsituation durch.

Abstract

Purpose To evaluate the results of interventional endovascular therapy of incidental and symptomatic visceral artery aneurysms in the elective and emergency situation.

Materials and Methods 43 aneurysms in 38 patients (19 female, 19 male, mean age: 57 ± 16 years [18 – 82]) were treated between 2011 and 2015. The characteristics of the aneurysms (true vs. false aneurysm, size, etiology, location, symptoms) were considered. Furthermore, we evaluated the intervention with respect to technical success, embolic/occlusive agents used, therapy-associated complications and postinterventional follow-up.

Results 23 true aneurysms (maximum diameter: 22 ± 18 mm [11 – 67 mm]) and 20 false aneurysms (maximum diameter: 9 ± 33 mm [3 – 150 mm]) were evaluated. The splenic (n = 14) and renal arteries (n = 18) were most frequently affected. The etiology was most commonly degenerative-atherosclerotic (47 %) or iatrogenic post-operative (19 %). 18/48 interventions were performed due to active bleeding. False aneurysms were associated significantly more often with active bleeding (63 vs. 25 %, p = 0.012). 41/48 treatments were technically successful. Re-intervention was necessary 6 times. In 2 cases the endovascular approach did not succeed. There was a complication rate of 10 %, whereby only 4 minor and 1 major complications occurred. No patient suffered from permanent sequelae. Aneurysms were primarily treated by using coils and if necessary additional embolic agents (liquid embolic agent or vascular plugs) (75 %). In the follow-up period, reperfusion of treated aneurysms occurred at a rate of 7 % (n = 3). Conclusion Interventional endovascular therapy of visceral artery aneurysms is safe and effective in the elective treatment of incidental aneurysms as well as in significantly more frequent hemorrhaging false aneurysms in the emergency situation.

Kernaussagen

• Die Genese der in der Studie untersuchten Aneurysmen und Pseudoaneurysmen war am häufigsten atherosklerotisch (47 % der Fälle) oder iatrogen postoperativ (19 % der Fälle).

• Vornehmlich wurden die Aneurysmen in der Studie mithilfe von Coils und ggf. zusätzlichen Embolisaten (Flüssigembolisat, Vascular Plug) versorgt.

• Die interventionelle endovaskuläre Behandlung von Aneurysmen der viszeralen Arterien ist ein sicheres und erfolgreiches Verfahren, denn kein Patient litt postinterventionell an dauerhaften therapiebedingten Folgeschäden. Dies gilt sowohl für die elektive Versorgung inzidenteller Aneurysmen als auch für die Therapie signifikant häufiger blutender Pseudoaneurysmen in der Notfallsituation.

• Pseudoaneurysmen viszeraler Arterien sind in mehr als 60 % der Fälle mit aktiver oder stattgehabter Blutung assoziiert. Daraus ergibt sich die Notwendigkeit einer (interventionellen) Therapie auch bei geringer Größe.

• Die postinterventionelle Nachsorge scheint zur Detektion von Reperfusion als Zeichen des Therapieversagens sinnvoll.

Schlüsselwörter

Aneurysma viszeraler Arterien - Pseudoaneurysma viszeraler Arterien - akute Blutung - endovaskuläre Therapie

Keywords

visceral artery aneurysm - visceral artery pseudoaneurysm - acute bleeding - endovascular therapy

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