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Aktuelle Kardiologie 2022; 11(02): 166-176
DOI: 10.1055/a-1746-8079
Kurzübersicht

Update Aortenerkrankungen

Update aortic diseases
Sigrid Nikol
1   Klinische und Interventionelle Angiologie, Asklepios Kliniken Hamburg GmbH, Hamburg, Deutschland (Ringgold ID: RIN9216)
,
Laetitia Nikol
2   Medical School, Stradiņš-Universität Riga, Lettland,
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Zusammenfassung

Die vorliegende Arbeit berichtet über die neuesten wissenschaftlichen Erkenntnisse im Zusammenhang mit Aortenaneurysmen und -dissektionen. Schwerpunkt hierbei sind die Pathophysiologie und Genetik, der Einfluss von Fluorochinolonen auf Aortenaneurysmen und -dissektionen sowie Marker der Aortitis. Ferner werden die wichtigsten aktuellen Leitlinienempfehlungen aus den Jahren 2017 bis 2020 zusammengefasst – der Fokus liegt hierbei auf dem Screening, der Diagnostik, den Grenzwerten für die Therapieindikationen, der Art und den technischen Details der Behandlung sowie Nachsorge von Aneurysmen der Aorta ascendens, des Aortenbogens, der Aorta descendens und abdominalis, Penetrating aortic Ulcers, bei genetisch bedingten Bindegewebserkrankungen mit Aortenbeteiligungen, Aortitis und mykotischen Aneurysmen.

Abstract

The most recent scientific findings related to aortic aneurysms and dissections are reported for pathophysiology and genetics and the role of fluoroquinolones for aortic aneurysms and dissections, as well as markers of aortitis. Furthermore, most important guideline recommendations of the years 2017 until 2020 are summarized for the screening, diagnostics, indication of therapy, type and technical details of therapy and follow-up of aneurysms of the ascending aorta, aortic arch, descending aorta, abdominal aorta, penetrating aortic ulcers, genetically-related connective tissue diseases with aortic involvement, aortitis and mycotic aneurysms.

Was ist wichtig?

  • Frauen haben schlechtere Verläufe als Männer, werden dennoch weniger gescreent.

  • Diabetes mellitus korreliert negativ mit der Entwicklung von abdominellen Aortenaneurysmen.

  • Die Rolle von Inflammationsmarkern und Non-coding-mRNA wurde näher erforscht.

  • Neue Tiermodelle für Aortenaneurysmen wurden entwickelt und Gewebsbanken eingerichtet.

  • Fluoroquinolone sollten nicht bei Patienten mit einem Risikoprofil für Aortenaneurysmen eingesetzt werden.

  • Neue Radiotracer wurden identifiziert.

  • Screening für abdominelle Aortenaneurysmen wird für Männer empfohlen.

  • Die Grenzwerte für Aortendurchmesser für eine Therapieindikation wurden in den aktuellen Leitlinien angehoben.

  • Die endovaskuläre Versorgung wird in den meisten Fällen inzwischen bevorzugt.

Schlüsselwörter

Aneurysma - Dissektion - Aortitis - endovaskuläre Therapie - rupturiertes Aortenaneurysma

Keywords

aneurysm - dissection - ruptured aortic aneurysm - aortitis - endovascular therapy


Publikationsverlauf

Artikel online veröffentlicht:
12. April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Boczar KE, Cheung K, Boodhwani M. et al. Sex Differences in Thoracic Aortic Aneurysm Growth. Hypertension 2019; 73: 190-196
    CrossrefPubMedSuche in Google Scholar
  • 2 Paige E, Clément M, Lareyre F. et al. Interleukin-6 Receptor Signaling and Abdominal Aortic Aneurysm Growth Rates. Circ Genom Precis Med 2019; 12: e002413
    CrossrefPubMedSuche in Google Scholar
  • 3 Tang D, Han Y, Lun Y. et al. Y chromosome loss is associated with age-related male patients with abdominal aortic aneurysms. Clin Interv Aging 2019; 14: 1227-1241
    CrossrefPubMedSuche in Google Scholar
  • 4 Son BK, Kojima T, Ogawa S. et al. Testosterone inhibits aneurysm formation and vascular inflammation in male mice. J Endocrinol 2019; 241: 307-317
    CrossrefPubMedSuche in Google Scholar
  • 5 Duijnhouwer AL, Bons LR, Timmers H. et al. Aortic dilatation and outcome in women with Turner syndrome. Heart 2019; 105: 693-700
    CrossrefPubMedSuche in Google Scholar
  • 6 D’Cruz RT, Wee IJY, Syn NL. et al. The association between diabetes and thoracic aortic aneurysms. J Vasc Surg 2019; 69: 263-268.e1
    CrossrefPubMedSuche in Google Scholar
  • 7 Piacentini L, Werba JP, Bono E. et al. Genome-Wide Expression Profiling Unveils Autoimmune Response Signatures in the Perivascular Adipose Tissue of Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2019; 39: 237-249
    CrossrefPubMedSuche in Google Scholar
  • 8 Gu BH, Choi JC, Shen YH. et al. Elastin-Specific Autoimmunity in Smokers With Thoracic Aortic Aneurysm and Dissection is Independent of Chronic Obstructive Pulmonary Disease. J Am Heart Assoc 2019; 8: e011671
    CrossrefPubMedSuche in Google Scholar
  • 9 Liu CL, Ren J, Wang Y. et al. Adipocytes promote interleukin-18 binding to its receptors during abdominal aortic aneurysm formation in mice. Eur Heart J 2020; 41: 2456-2468
    CrossrefPubMedSuche in Google Scholar
  • 10 Suehiro C, Suzuki J, Hamaguchi M. et al. Deletion of interleukin-18 attenuates abdominal aortic aneurysm formation. Atherosclerosis 2019; 289: 14-20
    CrossrefPubMedSuche in Google Scholar
  • 11 Akiyama M, Kaneko Y, Takeuchi T. Characteristics and prognosis of IgG4-related periaortitis/periarteritis: A systematic literature review. Autoimmun Rev 2019; 18: 102354
    CrossrefPubMedSuche in Google Scholar
  • 12 Wu ZY, Trenner M, Boon RA. et al. Long noncoding RNAs in key cellular processes involved in aortic aneurysms. Atherosclerosis 2020; 292: 112-118
    CrossrefPubMedSuche in Google Scholar
  • 13 Kumar S, Boon RA, Maegdefessel L. et al. Role of Noncoding RNAs in the Pathogenesis of Abdominal Aortic Aneurysm. Circ Res 2019; 124: 619-630
    CrossrefPubMedSuche in Google Scholar
  • 14 Tingting T, Wenjing F, Qian Z. et al. The TGF-β pathway plays a key role in aortic aneurysms. Clin Chim Acta 2020; 501: 222-228
    CrossrefPubMedSuche in Google Scholar
  • 15 Cullen JM, Lu G, Shannon AH. et al. A novel swine model of abdominal aortic aneurysm. J Vasc Surg 2019; 70: 252-260.e2
    CrossrefPubMedSuche in Google Scholar
  • 16 Jalalzadeh H, Indrakusuma R, Blankensteijn JD. et al. Design and protocol of a comprehensive multicentre biobank for abdominal aortic aneurysms. BMJ Open 2019; 9: e028858
    CrossrefPubMedSuche in Google Scholar
  • 17 Pelisek J, Hegenloh R, Bauer S. et al. Biobanking: Objectives, Requirements, and Future Challenges-Experiences from the Munich Vascular Biobank. J Clin Med 2019; 8: 251
    CrossrefPubMedSuche in Google Scholar
  • 18 Meng L, Huang J, Jia Y. et al. Assessing fluoroquinolone-associated aortic aneurysm and dissection: Data mining of the public version of the FDA adverse event reporting system. Int J Clin Pract 2019; 73: e13331
    CrossrefPubMedSuche in Google Scholar
  • 19 Rawla P, El Helou ML, Vellipuram AR. Fluoroquinolones and the Risk of Aortic Aneurysm or Aortic Dissection: A Systematic Review and Meta-Analysis. Cardiovasc Hematol Agents Med Chem 2019; 17: 3-10
    CrossrefPubMedSuche in Google Scholar
  • 20 Noman AT, Qazi AH, Alqasrawi M. et al. Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis. Int J Cardiol 2019; 274: 299-302
    CrossrefPubMedSuche in Google Scholar
  • 21 Yu X, Jiang DS, Wang J. et al. Fluoroquinolone Use and the Risk of Collagen-Associated Adverse Events: A Systematic Review and Meta-Analysis. Drug Saf 2019; 42: 1025-1033
    CrossrefPubMedSuche in Google Scholar
  • 22 Toczek J, Bordenave T, Gona K. et al. Novel Matrix Metalloproteinase 12 Selective Radiotracers for Vascular Molecular Imaging. J Med Chem 2019; 62: 9743-9752
    CrossrefPubMedSuche in Google Scholar
  • 23 Bardi M, Diamantopoulos AP. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice summary. Radiol Med 2019; 124: 965-972
    CrossrefPubMedSuche in Google Scholar
  • 24 Gandhi R, Cawthorne C, Craggs LJL. et al. Cell proliferation detected using [(18)F]FLT PET/CT as an early marker of abdominal aortic aneurysm. J Nucl Cardiol 2021; 28: 1961-1971
    CrossrefPubMedSuche in Google Scholar
  • 25 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
    CrossrefPubMedSuche in Google Scholar
  • 26 AWMF. S2k-Leitlinie Typ B Aortendissektion. AWMF-Registrier-Nr. 004–034. 2018 Zugriff am 24. Februar 2022 unter: https://www.awmf.org/leitlinien/detail/ll/004–034.html
    Suche in Google Scholar
  • 27 Czerny M, Schmidli J, Adler S. et al. Editor’s Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2019; 57: 165-198
    CrossrefPubMedSuche in Google Scholar
  • 28 Wanhainen A, Verzini F, Van Herzeele I. et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57: 8-93
    CrossrefPubMedSuche in Google Scholar
  • 29 Schirmer JH, Aries PM, Balzer K. et al. S2k-Leitlinie: Management der Großgefäßvaskulitiden. Z Rheumatol 2020; 79 (Suppl. 03) 67-95
    CrossrefPubMedSuche in Google Scholar
  • 30 Dombrowski D, Long GW, Chan J. et al. Screening Chest Computed Tomography is Indicated in All Patients with Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 65: 190-195
    CrossrefPubMedSuche in Google Scholar
  • 31 Skibba AA, Evans JR, Hopkins SP. et al. Reconsidering gender relative to risk of rupture in the contemporary management of abdominal aortic aneurysms. J Vasc Surg 2015; 62: 1429-1436
    CrossrefPubMedSuche in Google Scholar
  • 32 Heikkinen M, Salenius JP, Auvinen O. Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg 2002; 36: 291-296
    CrossrefPubMedSuche in Google Scholar
  • 33 Deery SE, Soden PA, Zettervall SL. et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg 2017; 65: 1006-1013
    CrossrefPubMedSuche in Google Scholar
  • 34 Lo RC, Bensley RP, Hamdan AD. Vascular Study Group of New England. et al. Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England. J Vasc Surg 2013; 57: 1261-1268.e5
    CrossrefPubMedSuche in Google Scholar
  • 35 Lo RC, Lu B, Fokkema MT. et al. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg 2014; 59: 1209-1216
    CrossrefPubMedSuche in Google Scholar
  • 36 Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. J Vasc Surg 2016; 63: 839-844
    CrossrefPubMedSuche in Google Scholar
  • 37 Ulug P, Sweeting MJ, von Allmen RS. et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet 2017; 389: 2482-2491
    CrossrefPubMedSuche in Google Scholar
  • 38 Sweet MP, Fillinger MF, Morrison TM. et al. The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2011; 54: 931-937
    CrossrefPubMedSuche in Google Scholar
  • 39 Powell JT, Sweeting MJ, Ulug P. et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 2017; 104: 166-178
    CrossrefPubMedSuche in Google Scholar
  • 40 Ash J, Chandra V, Rzucidlo E. et al. LUCY results show females have equivalent outcomes to males following endovascular abdominal aortic aneurysm repair despite more complex aortic morphology. J Vasc Surg 2020; 72: 566-575.e4
    CrossrefPubMedSuche in Google Scholar
  • 41 Edman NI, Schanzer A, Crawford A. et al. Sex-related outcomes after fenestrated-branched endovascular aneurysm repair for thoracoabdominal aortic aneurysms in the U.S. Fenestrated and Branched Aortic Research Consortium. J Vasc Surg 2021; 74: 861-870
    CrossrefPubMedSuche in Google Scholar
  • 42 Oliver-Williams C, Sweeting MJ, Jacomelli J. et al. Safety of Men With Small and Medium Abdominal Aortic Aneurysms Under Surveillance in the NAAASP. Circulation 2019; 139: 1371-1380
    CrossrefPubMedSuche in Google Scholar
  • 43 Choong A, Marjot J, Wee IJY. et al. Forecasting aortic aneurysm rupture: A systematic review of seasonal and atmospheric associations. J Vasc Surg 2019; 69: 1615-1632.e17
    CrossrefPubMedSuche in Google Scholar
  • 44 Singh TP, Wong SA, Moxon JV. et al. Systematic review and meta-analysis of the association between intraluminal thrombus volume and abdominal aortic aneurysm rupture. J Vasc Surg 2019; 70: 2065-2073.e10
    CrossrefPubMedSuche in Google Scholar
  • 45 Wortmann M, Böckler D, Geisbüsch P. Perioperative cerebrospinal fluid drainagefor the prevention of spinal ischemia after endovascular aortic repair. Gefaesschirurgie 2017; 22 (Suppl. 02) 35-40
    CrossrefPubMedSuche in Google Scholar
  • 46 Belvroy VM, de Beaufort HWL, van Herwaarden JA. et al. Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review. Ann Vasc Surg 2020; 62: 474-483
    CrossrefPubMedSuche in Google Scholar
  • 47 Rhee R, Oderich G, Hertault A. et al. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2020; 72: 1043-1049
    CrossrefPubMedSuche in Google Scholar