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Gefäßmedizin Scan - Zeitschrift für Angiologie, Gefäßchirurgie, diagnostische und interventionelle Radiologie 2021; 8(01): 41-51
DOI: 10.1055/a-1269-3761
CME-Fortbildung

Chronisch-thromboembolische pulmonale Hypertonie: pulmonale Ballonangioplastie

Jan B. Hinrichs
,
Karen M. Olsson
,
Frank K. Wacker
,
Bernhard C. Meyer
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Als Ursache der CTEPH (chronisch-thromboembolische pulmonale Hypertonie) wird die inkomplette Auflösung thromboembolischen Materials nach Lungenarterienembolien mit konsekutiver Umwandlung in fibröse Gewebsstränge angesehen. Für inoperable CTEPH-Patienten wurde in den letzten Jahren die BPA (perkutane pulmonale Ballonangioplastie) weiterentwickelt. Der Beitrag gibt einen Überblick über Indikationsstellung, Technik und mögliche Komplikationen.
Kernaussagen

  • Als ursächlich für die CTEPH wird die inkomplette Auflösung thromboembolischen Materials nach Lungenarterienembolien mit konsekutiver Umwandlung in fibröse Gewebsstränge angesehen.

  • Die Behandlungsmethode der Wahl ist die PEA in dafür spezialisierten CTEPH-Zentren. Im Falle von inoperablen, oft peripher gelegenen vaskulären Befunden oder persistierender bzw. rezidivierender pulmonaler Hypertonie nach PEA ist Riociguat als medikamentöse Therapie zugelassen und etabliert.

  • Als interventionelles Verfahren wurde in den letzten Jahren die BPA für inoperable CTEPH-Patienten stetig weiterentwickelt und zunehmend etabliert. Ziel der BPA ist es, in der Lungenstrombahn peripher gelegene Befunde wie intraluminale Webs und bandartige Stenosen, aber auch komplette Verschlüsse der Lungenarterien nach vorheriger Drahtpassage mittels Ballondilatation wieder zu eröffnen. Dadurch soll eine Verbesserung der Perfusion mit Verminderung des pulmonalvaskulären Widerstands und Senkung des pulmonalarteriellen Druckes erreicht werden. Typischerweise sind mehrere Sitzungen zur Behandlung der gesamten pulmonalarteriellen Lungenstrombahn notwendig.

  • Komplikationen nach BPA treten bei ca. 10 – 30 % der Interventionen auf. Typisch sind Bluthusten, Dissektionen oder Perforationen von Lungenarterien, das sog. Reperfusionsödem, Einblutungen in das Lungenparenchym und blutige Pleuraergüsse. Schwerwiegende Blutungskomplikationen sind sehr selten, können allerdings zum Tod des Patienten führen.

  • Die Ergebnisse der BPA hinsichtlich der pulmonalen Hämodynamik und der körperlichen Belastbarkeit sind positiv. Trotz einer weltweiten Verbreitung der Methode fehlen allerdings noch prospektive Langzeitdaten in größeren Patientengruppen.



Publication History

Article published online:
10 March 2021

© 2021. Thieme. All rights reserved.

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