Zusammenfassung
Die interventionelle Therapie von Erkrankungen des Aortenbogens zählt zu den aktuellen großen Herausforderungen der interventionellen Gefäßmedizin. Die Schwierigkeiten des endovaskulären Zugangs für die oft großkalibrigen Stentprothesen, die Krümmung des Aortenbogens mit den daraus resultierenden Appositionsschwierigkeiten der rigiden Implantate, die stark variable Anatomie abgehender supraaortaler Arterien und die häufig komplexe Morphologie der Erkrankungen mit Einbeziehung abgehender Aortenbogengefäße stellen nur einige der operativen Schwierigkeiten dar. Therapeutische Manipulationen im Aortenbogen sind mit dem Risiko der Embolisierung von soliden Bestandteilen, Thrombus und Luft und dem Risiko der Verlegung von hirnversorgenden Arterien verbunden. Im Falle des Auftretens intraoperativer Komplikationen ist im Gegensatz zu weiter distal gelegenen Aorteninterventionen die Konversion zum offen-chirurgischem Vorgehen mit größeren instrumentell-technischen Anforderungen (z. B. extrakorporale Zirkulation) und anderen Schwierigkeiten verbunden. Interventionen am Aortenbogen sollten daher nur in Zentren erfolgen, die alle technischen und fachlichen Voraussetzungen für endovaskuläre und offene Eingriffe an der herznahen Aorta vorhalten.
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Literatur
Chuter TA, Schneider DB (2007) Endovascular repair of the aortic arch. Perspect Vasc Surg Endovasc Ther 19(2):188–192
Criado FJ (2007) A percutaneous technique for preservation of arch branch patency during thoracic endovascular aortic repair (TEVAR): retrograde catheterization and stenting. J Endovasc Ther 14(1):54–58
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP (1994) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331(26):1729–1734
Dieter RS, Nelson B, Wolff MR, Thornton F, Grist TM, Cohen DM (2003) Transseptal stent treatment of anastomotic stricture after repair of partial anomalous pulmonary venous return. J Endovasc Ther 10(4):838–842
Dorros G, Dorros AM, Planton S, O'Hair D, Zayed M (2000) Transseptal guidewire stabilization facilitates stent-graft deployment for persistent proximal ascending aortic dissection. J Endovasc Ther 7(6):506–512
Hinchliffe RJ, Ivancev K (2008) Endovascular aneurysm repair: current and future status. Cardiovasc Intervent Radiol 31(3):451–459
Hinchliffe RJ, Ivancev K, Sonesson B, Malina M (2007a) „Paving and cracking“: an endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries. J Endovasc Ther 14(5):630–633
Hinchliffe RJ, Krasznai A, Schultzekool L, Blankensteijn JD, Falkenberg M, Lonn L et al (2007b) Observations on the failure of stent-grafts in the aortic arch. Eur J Vasc Endovasc Surg 34(4):451–456
Inoue K, Hosokawa H, Iwase T, Sato M, Yoshida Y, Ueno K et al (1999) Aortic arch reconstruction by transluminally placed endovascular branched stent graft. Circulation 100(19 Suppl):II316–II321
Joseph G, Krishnaswami S, Baruah DK, Kuruttukulam SV, Abraham OC (1997) Transseptal approach to aortography and carotid artery stenting in pulseless disease. Catheter Cardiovasc Diagn 40(4):416–420; discussion 21
Kahlert P, Eggebrecht H, Jánosi RA, Hildebrandt HA, Plicht B, Tsagakis K, Jakob HG et al (2014) Silent cerebral ischemia after thoracic endovascular aortic repair: a neuroimaging study. Ann Thorac Surg 98(1):53–58
Kölbel T, Resch TA, Dias N, Bjorses K, Sonesson B, Malina M (2009a) Staged proximal deployment of the Zenith TX2 thoracic stent-graft: a novel technique to improve conformance to the aortic arch. J Endovasc Ther 16(5):598–602
Kölbel T, Dias N, Resch T, Holst J, Sonesson B, Malina M (2009b) In situ bending of thoracic stent grafts: clinical application of a novel technique to improve conformance to the aortic arch. J Vasc Surg 49(6):1613–1616
Kölbel T, Rohlffs F, Wipper S, Carpenter SW, Debus ES, Tsilimparis N (2016) Carbon dioxide flushing technique to prevent cerebral arterial air embolism and stroke during TEVAR. J Endovasc Ther 23(2):393–395
Lansky AJ, Messé SR, Brickman AM, Dwyer M, Van Der Worp HB, Lazar RM, Browndyke J et al (2017) Proposed standardized neurological endpoints for cardiovascular clinical trials: an academic research consortium initiative. J Am Coll Cardiol 69(6):679–691
Leurs LJ, Bell R, Degrieck Y, Thomas S, Hobo R, Lundbom J (2004) Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 40(4):670–679; discussion 9–80
MacDonald S, Cheung A, Sidhu R, Rheaume P, Grenon SM, Clement J (2009) Endovascular aortic aneurysm repair via the left ventricular apex of a beating heart. J Vasc Surg 49(3):759–762
Malina M, Brunkwall J, Ivancev K, Lindblad B, Malina J, Nyman U et al (1998) Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion. J Endovasc Surg 5(3):274–277
McWilliams RG, Murphy M, Hartley D, Lawrence-Brown MM, Harris PL (2004) In situ stent-graft fenestration to preserve the left subclavian artery. J Endovasc Ther 11(2):170–174
Mitchell RS, Ishimaru S, Ehrlich MP, Iwase T, Lauterjung L, Shimono T et al (2002) First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther 9(Suppl 2):II98–I105
Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD (2009) Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat 31(5):319–323
Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M (2008) The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 15(4):427–432
Rohlffs F, Tsilimparis N, Trepte C, Kratzberg J, Mogensen J, Debus ES, Kölbel T (2018) Air embolism during TEVAR: an additional flush port on the delivery system pusher significantly reduces the amount of air released during deployment of a thoracic stent-graft in an experimental setting. J Endovasc Ther 25(4):435–439
Rohlffs F, Trepte C, Ivancev K, Tsilimparis N, Makaloski V, Debus ES, Kölbel T (2019) Air embolism during TEVAR: liquid perfluorocarbon absorbs carbon dioxide in a combined flushing technique and decreases the amount of gas released from thoracic stent-grafts during deployment in an experimental setting. J Endovasc Ther 26(1):76–80
Sonesson B, Resch T, Allers M, Malina M (2009 Jun) Endovascular total aortic arch replacement by in situ stent graft fenestration technique. J Vasc Surg 49(6):1589–1591
Spear R, Haulon S, Ohki T, Tsilimparis N, Kanaoka Y, Milne CPE, Kölbel T et al (2016) Editor's choice–subsequent results for arch aneurysm repair with inner branched endografts. Eur J Vasc Endovasc Surg 51(3):380–385
Wipper S, Lohrenz C, Peymann K, Russ D, Kersten JF, Carpenter SW, Kölbel T et al (2012) Hemodynamic impact of transseptal access to the ascending aorta in a porcine model. J Endovasc Ther 19(5):679–688
Wipper S, Lohrenz C, Ahlbrecht O, Diener H, Carpenter SW, Detter C, Kölbel T et al (2013). Antegrade side branch access in branched aortic arch endografts: a porcine feasibility study. J Endovasc Ther 20(2):233–241
Wipper S, Lohrenz C, Ahlbrecht O, Carpenter SW, Tsilimparis N, Kersten JF, Kölbel T et al (2015) Transcardiac endograft delivery for endovascular treatment of the ascending aorta: a feasibility study in pigs. J Endovasc Ther 22(3):375–384
Yamaguchi MSK, Tsukube T et al (2008) Curved nitinol stent-graft placement for treating blunt thoracic aortic injury: an early experience. Ann Thorac Surg 86(3):780–786
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Kölbel, T., Debus, E.S. (2019). Aneurysmen des Aortenbogens: Interventionelle Therapie. In: Debus, E., Gross-Fengels, W. (eds) Operative und interventionelle Gefäßmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45856-3_64-1
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DOI: https://doi.org/10.1007/978-3-662-45856-3_64-1
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