Neue Risikoeinschätzung der Aortendissektion^[*]

Fazit

Die Aortendissektion ist ein akutes, lebensbedrohliches Krankheitsbild, das ohne schnelle und gezielte Diagnostik und Therapie eine äußerst ungünstige Prognose hat. Das Hauptsymptom ist der akute Thoraxschmerz. Die klinische Symptomatik kann von neurologischen Symptomen überlagert sein und zu Fehldiagnosen und Zeitverlust führen.

Die Diagnostik der Wahl beinhaltet eine frühzeitige, suffiziente Bildgebung. Hierbei stehen CT, TEE und MRT im Vordergrund.

Das Spektrum von akuten Komplikationen reicht von Myokardinfarkt, Perikardtamponade und Aortenruptur bis zur klinisch inapparenten Malperfusion von Organen oder Extremitäten.

Eine Typ-A-Dissektion wird chirurgisch versorgt. Typ-B-Dissektionen sollten in Abhängigkeit von Risikokonstellationen konservativ, medikamentös oder zusätzlich interventionell mit TEVAR behandelt werden. Das Spektrum der Risikomerkmale einer Typ-B-Dissektion erweitert sich von Zeichen der Organ- und Extremitätenmalperfusion und drohender Ruptur mit Hypotonie und Schockzeichen um persistierende Schmerzsyndrome, refraktäre Hypertonie, frühzeitige klinisch inapparente Expansion des falschen Lumens, großes Entry, Inflammation der dissezierten Aortenwand und partieller Thrombosierung des falschen Lumens.

^* Dieser Artikel ist ein adaptierter Zweitabdruck des Beitrags in: Kardiologie up2date 2014; 10:79 – 89

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