Skip to main content

Advertisement

SpringerLink
Log in

Technik des offenen Bauchaortenersatzes

Technique of open abdominal aortic replacement

  • Operative Techniken
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Das Bauchaortenaneurysma ist eine unterschätzte Entität, deren Prävalenz in der Risikogruppe älterer Männer (> 65 Jahre) bis zu 9% betragen kann und die durch Ruptur für etwa 2% der Todesfälle in dieser Gruppe verantwortlich ist. Bauchaortenaneurysmen sind in der Mehrzahl der Fälle infrarenal lokalisiert; in ca. 5% erstreckt sich das Aneurysma kranial bis auf Höhe der Nierenarterien (juxtarenal). Die offen-chirurgische Therapie des Bauchaortenaneurysmas, die bei symptomfreien Patienten ab einem maximalen Querdurchmesser von 5,5 cm indiziert ist, ist mit einer Mortalität von 1–2% in hochspezialisierten Zentren bzw. 4,3% in randomisierten multizentrischen Studien vergesellschaftet. Das Operationsprinzip besteht im Ersatz des aneurysmatischen Gefäßabschnitts durch prothetisches Material. Die Möglichkeiten des Ersatzes orientieren sich an der Ausdehnung des Aneurysmas und umfassen die Implantation einer Rohr- bzw. Bifurkationsprothese. Technische Besonderheiten wie etwa beim retroperitonealen Zugang, zur Rekonstruktion der Iliakalbifurkation und zum Vorgehen bei juxtarenalem, inflammatorischem und rupturiertem Aneurysma werden im folgenden Beitrag detailliert dargestellt.

Abstract

Abdominal aortic aneurysms have a prevalence of up to 9% in the subgroup of elderly (> 65 years) men and are responsible for approximately 2% of deaths in this group due to aneurysm rupture. Abdominal aortic aneurysms are most frequently confined to the infrarenal aorta; however, in 5% of cases they may extend proximally to the renal arteries (juxtarenal aneurysms). Open surgery for abdominal aortic aneurysms is indicated at a diameter over 5.5 cm in asymptomatic patients and is accompanied by mortality between 1 and 2% in specialized centres and 4.3% in randomized multicentre studies. The principle of surgical therapy is replacement of the diseased aorta by implantation of a prosthetic graft. Depending on the extent of the aneurysm, tube grafts or bifurcated grafts can be utilized. In this article operative details of the implantation of tube and bifurcated grafts as well as additional techniques for the treatment of juxtarenal, inflammatory and ruptured aneurysms will be presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12

Literatur

  1. Ashton AH, Buxton MJ, Day NE et al (2002) The multicentre aneurysm screening study (MASS) into the effect of aortic abdominal aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360:1531–1539

    Article  PubMed  CAS  Google Scholar 

  2. Singh K, Bonaa KH, Jacobsen BK, Bjork L et al (2001) Prevalence and risk factors for abdominal aortic aneurysms in a population-based study. The Tromso Study. Am J Epidemiol 154:236–244

    Article  PubMed  CAS  Google Scholar 

  3. Debus ES, Kölbel T, Böckler D, Eckstein HH (2010) Abdominelle Aortenaneurysmen. Gefasschirurgie 15:154–168

    Article  Google Scholar 

  4. Gordon JR, Wahls T, Carlos RC et al (2009) Failure to recognize newly identified aortic dilations in a health care system with an advanced electronic medical record. Ann Intern Med 151:21

    PubMed  Google Scholar 

  5. Torsello G, Can A, Schumacher S (2005) Das Bauchaortenaneurysma. Gefasschirurgie 10:139–153

    Article  Google Scholar 

  6. Anjum A, Allmen R von, Greenhalgh R, Powell JT (2012) Explaining the decrease in mortality from abdominal aortic aneurysm rupture. Br J Surg 99:637–645

    Article  PubMed  CAS  Google Scholar 

  7. Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms – clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Sur (Suppl1)41:1–58

    Article  Google Scholar 

  8. Powell JT, Greenhalgh RM (2003) Clinical practice. Small abdominal aortic aneurysms. N Engl J Med 348:1895–1901

    Article  PubMed  Google Scholar 

  9. The United Kingdom Small Aneurysm Trial Participants (2002) Long-term outcomes of immediate repair compared with surveillance for small abdominal aortic aneurysms. N Engl J Med 346:1445–1452

    Article  Google Scholar 

  10. Dubost C, Allary M, Oeconomos N (1951) Treatment of aortic aneurysms. Removal of the aneurysm. Re-establishment of continuity by grafts of preserved human aorta. Mem Acad Chir (Paris) 77:381–383

    Google Scholar 

  11. Hertzer NR, Mascha EJ, Karafa MT et al (2002) Open infrarenal abdominal aortic aneurysm repair: the Cleveland clinic experience from 1989 to 1998. J Vasc Surg 25:277–284

    Google Scholar 

  12. Pfeiffer T, Reiher L, Sandmann W et al (2000) Results of conventional surgical therapy of abdominal aortic aneurysms since the beginning of the endovascular era. Chirurg 71:72–79

    Article  PubMed  CAS  Google Scholar 

  13. Brown LC, Powell JT, Thompson SG et al (2012) The UK Endovascular aneurysm repair (EVAR) trials: randomized trials of EVAR versus standard therapy. Health Technol Assess 16:1–218

    PubMed  CAS  Google Scholar 

  14. The Danish Vascular Registry Report (2001) http://www.karbase.dk

  15. Umscheid T, Eckstein HH, Noppeney T et al (2001) Qualitätsmanagement Bauchaortenaneurysma der Deutschen Gesellschaft für Gefäßchirurgie (DGG)-Ergebnisse. Gefasschirurgie 6:194–200

    Article  Google Scholar 

  16. Allen RC, Schneider J, Longenecker L et al (1993) Paraanastomotic aneurysms of the abdominal aorta. J Vasc Surg 18:424–431

    Article  PubMed  CAS  Google Scholar 

  17. Wenk H, Meyer H (2002) Late complications in the aorta and iliac artery following open aortic surgery. Zentralbl Chir 127:95–98

    Article  PubMed  CAS  Google Scholar 

  18. O’Brien T, Collin J (1992) Prosthetic vascular graft infection. Br J Surg 79:1262–1267

    Article  Google Scholar 

  19. Lehnert T, Gruber HE, Allenberg JR et al (1993) Management of primary aortic graft infection by extra-anatomic bypass reconstruction. Eur J Vasc Endovasc Surg 7:301–307

    CAS  Google Scholar 

  20. Johnston KW (1989) Multicenter prospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality J Vasc Surg 9:437–447

    CAS  Google Scholar 

  21. Knott AW, Kalra M, Duncan AA et al (2008) Open repair of juxtarenal aortic aneurysms (JAA) remains a safe option in the era of fenestrated endografts. J Vasc Surg 47:695–701

    Article  PubMed  Google Scholar 

  22. Shortell CK, Johansson M, Green RM et al (2003) Optimal operative strategies in repair of juxtarenal abdominal aortic aneurysms. Ann Vasc Surg 17:60–65

    Article  PubMed  Google Scholar 

  23. Kniemeyer HW, Kolvenbach R, Sandmann W et al (1990) Das inflammatorische Aneurysma der Aorta. Diagnose, Therapie, Ergebnisse. Chirurg 61:27–31

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Sektion Gefäßchirurgie, Klinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    F. Dünschede, C.F. Vahl &  B. Dorweiler

Authors
  1. F. Dünschede
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C.F. Vahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Dorweiler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Dorweiler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dünschede, F., Vahl, C. & Dorweiler, B. Technik des offenen Bauchaortenersatzes. Z Herz- Thorax- Gefäßchir 26, 356–365 (2012). https://doi.org/10.1007/s00398-012-0966-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-012-0966-y

Schlüsselwörter

Keywords

Search

Navigation