Aneurysmen an viszeralen Arterien

 

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Zusammenfassung

Viszeralarterienaneurysmen (VAA) sind seltene Krankheitsbilder. Ätiologisch können 2 Formen unterschieden werden: Echte VAA mit multifaktorieller Genese, wobei die Arteriosklerose ein bedeutender pathogenetischer Faktor ist, und Pseudoaneurysmen z. B. nach abdominellen Traumen oder inflammatorischen Prozessen. Am häufigsten sind VAA an der A. lienalis (60 %) und der A. hepatica communis (20–50 %) lokalisiert. Die höchsten Rupturraten sind für die A. hepatica communis (80 %) sowie die A. pancreaticoduodenalis (75 %) beschrieben. Generell besteht eine Therapieindikation ab einem Durchmesser von 2 cm. Eine Ausnahme besteht bei schwangeren Patientinnen. Hier muss wegen des stark erhöhten Rupturrisikos im letzen Trimenon vor allem bei Multipara eine frühzeitige Therapie erwogen werden. Für die Therapie existieren interventionelle, endovaskuläre (Embolisierung, Stent) oder chirurgische (Resektion mit direkter Gefäßanastomose, Interponat, Aneurysmoraphie, Ligatur) Verfahren. Die Wahl der Therapie muss dem individuellen Risikoprofil des Patienten angemessen sein. Im eigenen Patientengut (n = 19, 1996–2007) zeigen sich in Abhängigkeit von der klinischen Ausgangssituation sowohl interventionelle als auch chirurgische Verfahren als valide Therapieoptionen.

Abstract

Visceral artery aneurysms (VAA) are relatively rare disease patterns. Withregard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60 %) and common hepatic artery (20–50 %). The common hepatic artery (80 %) and the pancreatico-duodenal artery (75 %) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n = 19; 1996–2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.

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PD Dr. R. Croner

Universitätsklinikum Erlangen · Chirurgische Klinik und Poliklinik

Krankenhausstraße 12

91054 Erlangen

Deutschland

Phone: ++49 / 91 31 / 8 53 32 96

Fax: ++49 / 91 31 / 8 53 29 68

Email: roland.croner@uk-erlangen.de