Therapie des juxtarenalen Aortenaneurysmas

Juxtarenale Aortenaneurysmen machen 15% der Bauchaortenaneurysmen aus. Ihre Behandlung wird durch den kurzen bzw. nicht vorhandenen infrarenalen Hals erschwert. Dieser Beitrag enthält eine Übersicht über die gegenwärtigen offenen und endovaskulären Therapieoptionen, mit einem Fokus auf der elektiven und notfallmäßigen endovaskulären Versorgung der juxtarenalen Bauchaortenaneurysmen.

Abstract

Juxtarenal aortic aneurysms account for 15% of abdominal aortic aneurysms. Compared to infrarenal abdominal aortic aneurysm treatment is more complex due to the missing/short infrarenal neck (0–4mm). To achieve a successful exclusion of the aneurysm the reno-visceral segment has to be involved in treatment. Current standard treatment of elective juxtarenal aortic aneurysms is the custom made fenestrated endovascular aortic repair (cmFEVAR). It has mainly replaced open surgical treatment due to superior perioperative and short term mortality and morbidity. Long-term data did not show superior results of one method so far, but more re-interventions in endovascularly treated patients. In emergency settings surgeon modified fenestrated endovascular aortic repair (smFEVAR) is a valuable therapy option in experienced hands. This technique showed similar technical success and re-intervention rates compared to cmFEVAR. The chimney technique (chEVAR) is another endovascular option, but basically recommended in emergency settings without enough time for smFEVAR, and its use should be limited to two target vessels.

Kernaussagen

• Juxtarenale Aortenaneurysmen machen 15% der Bauchaortenaneurysmen aus.

• Die Behandlung wird durch den kurzen bzw. nicht vorhandenen infrarenalen Hals erschwert.

• Die endovaskuläre Behandlung mit der extra angefertigten fenestrierten Endoprothese (cmFEVAR) hat sich zur Standardbehandlungsmethode entwickelt.

• Die endovaskuläre Behandlung mittels cmFEVAR zeigt eine geringere Morbidität und Mortalität im perioperativen und kurzfristigen postoperativen Verlauf als die offen-chirurgische Behandlung.

• Im Langzeitverlauf zeitigen die offen-chirurgische Versorgung und die endovaskuläre Versorgung ähnliche Ergebnisse in Bezug auf Mortalität und Morbidität. Allerdings ist die Reinterventionsrate nach cmFEVAR höher als die nach offen-chirurgischer Behandlung.

• In der Notfallsituation erzielt die endovaskuläre Versorgung mittels chirurgisch modifizierter Endoprothese (smFEVAR) vergleichbare Ergebnisse bezüglich des technischen Erfolgs und der Reinterventionsraten wie die cmFEVAR.

• Die Chimney-Technik (ChEVAR) ist eine weitere endovaskuläre Behandlungsoption, die vor allem in Notfallsituationen zur Anwendung kommt, wenn keine Zeit zur Anfertigung einer smFEVAR-Prothese bleibt. Diese Methode wird jedoch aufgrund der erhöhten Typ-Ia-Endoleak-Rate nur in Notfallsituationen und für maximal 2 Zielgefäße empfohlen.

Schlüsselwörter

Juxtarenales Aortenaneurysma - extra angefertigte fenestrierte Endoprothese - chirurgisch modifizierte Endoprothese

Keywords

Juxtarenal aortic aneurysm - custom made fenestrated endograft - surgeon modified endograft

Publication History

Article published online:
01 March 2024

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