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Radiologie up2date 2017; 17(03): 251-271
DOI: 10.1055/s-0043-117968
Pulmonale und kardiovaskuläre Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie akuter Erkrankungen der thorakalen Aorta

Diagnostic and therapy of acute thoracic aortic diseases
Sebastian Schotten
,
Michael B. Pitton
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Publication History

Publication Date:
24 November 2017 (online)

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Zusammenfassung

Akute Erkrankungen der thorakalen Aorta sind zwar eher selten, aber lebensbedrohlich. Sie erfordern daher eine rasche Diagnostik und Therapie. Diagnostisch spielt dabei die CT-Angiografie die zentrale Rolle, therapeutisch stehen der offene Ersatz bei der Aorta ascendens und die endovaskulären Therapieverfahren bei der Aorta descendens an erster Stelle.

Abstract

Acute diseases of the thoracic aorta represent a relatively rare but life threatening spectrum of pathologies. The non-traumatic diseases are usually summarized by the term “acute aortic syndrome”. A timely diagnosis and initiation of therapy are cornerstones for the patient outcome. CT has become the standard imaging procedure due do its widespread availability and excellent sensitivity. Furthermore, CT is able to discriminate the variants of acute aortic diseases and to detect the wide spectrum of complications. The volumetric CT dataset is also the basis for planning of interventional procedures. Open surgical repair still represents the standard of care for acute pathologies of the ascending aorta while endovascular therapy, due to minimally invasive character and good outcome, has replaced open surgery in most cases of complicated lesions of the descending aorta.

Kernaussagen

  • Das Erkrankungsspektrum des akuten Aortensyndroms umfasst die klassische Aortendissektion, das intramurale Hämatom, das symptomatische penetrierende Aortenulkus und das symptomatische bzw. rupturierte Aortenaneurysma.

  • Das Leitsymptom des akuten Aortensyndroms ist der akut einsetzende Thoraxschmerz. Je nach Ausprägung der Läsion entwickeln sich weitere Symptome wie Schock, Organ- oder Extremitätenischämie, kardiale Dekompensation oder neurologische Symptome.

  • Die CT-Angiografie (bevorzugt mit EKG-Synchronisierung) stellt aufgrund ihrer breiten Verfügbarkeit und der hohen Sensitivität und Spezifität die Methode der Wahl zur Abklärung eines akuten Aortensyndroms dar. Eine native Phase hilft zur Differenzierung eines Wandhämatoms durch die typische Dichteanhebung der Aortenwand.

  • Während Dissektionen mit Beteiligung der Aorta ascendens (Stanford-Typ A) eine hohe Mortalität aufweisen und i. d. R. eine Indikation zur Notfalloperation darstellen, sind auf die Aorta descendens beschränkte Dissektionen (Stanford-Typ B) ohne Komplikationen häufig konservativ behandelbar.

  • Bei Komplikationen einer Typ-B-Dissektion oder nach operativer Sanierung einer Typ-A-Dissektion sind interventionelle Verfahren wie die Stentgraftimplantation (TEVAR), die Fenestrierung der Dissektionsmembran oder das Stenting von Seitenästen der Standard.

  • Traumatische Aortenverletzungen werden insbesondere bei Hochrasanzunfällen beobachtet und gehen mit einer hohen Mortalität einher. Prädilektionsstelle ist der Aortenisthmus. Während geringgradige Läsionen konservativ behandelt werden können, ist die endovaskuläre Versorgung mittels Stentprothesen die Methode der Wahl bei höhergradigen Verletzungen.

Schlüsselwörter

Aorta - akutes Aortensyndrom - endovaskuläre Behandlung

Key words

aorta - acute aortic Syndrome - TEVAR - endovascular treatment - aortic imaging
 

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