Welche Nachkontrolle ist bei endovaskulärer Versorgung von abdominellen Aortenaneurysmen empfehlenswert?

 

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Zusammenfassung

Die Mehrphasen-CT-Angiografie (MS-CTA) wird als Goldstandard in der Nachkontrolle von endovaskulär versorgten abdominellen Aortenaneurysmen betrachtet. Bei den häufig multimorbiden Patienten ist jedoch die Anwendung von jodhaltigem und potenziell nephrotoxischem Kontrastmittel eingeschränkt. Die farbkodierte Duplexsonografie (FKDS) und insbesondere die Kontrastmittel-verstärkte Sonografie (CEUS) ist eine nicht invasive Methode, die eine kostengünstige Beurteilung von Endoleaks ermöglicht. Weiterhin können die Prothesenschenkel sowie Viszeral- und Nierenarterien funktionell im Hinblick auf mögliche Stenosierungen untersucht werden. Viele verschiedene Studien zeigen die Sonografie der CTA zumindest gleichwertig in der Beurteilung von Endoleaks. Bei Patienten mit eingeschränkter Nierenfunktion ist die CEUS in Kombination mit der konventionellen Röntgenuntersuchung zur Kontrolle des Endoprothesensitzes und von Materialbrüchen geeignet.

Abstract

In the past, multislice computed tomography angiography (CTA) with arterial and venous phase was recommended as the gold standard in follow-up after endovascular abdominal aneurysm repair (EVAR). Iodine-containing contrast agents and frequent radiation exposure are limitations for use in elderly patients with chronic renal insufficiency. Colour-coded Doppler sonography (CCDS) and, especially, contrast-enhanced ultrasound (CEUS) are non-invasive methods that are time and cost effective. Both provide a reliable alternative to CTA in surveillance after EVAR. CEUS seems to be superior in characterisation of the type of endoleaks and can be established in order to reduce iodine-containing contrast agent and radiation exposure in follow-up. In contrast to CTA scans, CEUS can be offered to patients with chronic renal insufficiency and allows a dynamic examination and perfusion analysis (e. g., in fenestrated and branched stentgrafts). Routine combination with X-ray allows control of stentgraft material and location of the branches.

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PD Dr. K. Pfister

Universitätsklinikum Regensburg · Gefäß- und Endovaskuläre Chirurgie

Franz-Josef-Strauß-Allee 11

93053 Regensburg

Deutschland

Phone: +49 / 9 41 / 9 44 69 11

Fax: +49 / 9 41 / 9 44 69 10

Email: karin.pfister@klinik.uni-regensburg.de