Article

A better echocardiographic view to aortic dissection

European Heart Journal (Impact Factor: 14.72). 02/2010; 31(4):398-400. DOI: 10.1093/eurheartj/ehp404
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Available from: Rolf Alexander Jánosi, Jan 15, 2015
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    ABSTRACT: Die Malperfusion der Aorta und ihrer Seitenäste ist eine häufige Komplikation der Aortendissektion. Die durch die akute Aortendissektion drohende Minderperfusion von Organen ist eine der Hauptursachen für die hohe Mortalität und Morbidität bei diesen Patienten. Daher sind eine schnelle Diagnose, die Identifizierung der ischämiegefährdeten Organe und die umgehende Einleitung einer Therapie zur Reperfusion erforderlich, bevor es zu bleibenden Endorganschäden kommt. Erschwert wird dies durch die häufig initial nur diskret bestehenden Symptome, die durch eine verzögerte Therapie letztendlich fatal enden können. Die Abdeckung des primären Intimaeinrisses durch einen endovaskulären Stent-Graft führt nicht bei allen Patienten auch zu einer Aufhebung der viszeralen Malperfusion. Zur Reperfusion sind verschiedene Methoden wie die Fenestrierung der Dissektionsmembran, die endovaskuläre aortale Implantation von nichtgecoverten Stent-Grafts oder das direkte perkutane Stenting der aortalen Seitenäste entwickelt worden. Die direkte endovaskuläre Behandlung der Malperfusion bietet eine vielversprechende Alternative zur chirurgischen Rekonstruktion, da sie schnell zur Verfügung steht, weniger invasiv ist und ein geringeres Risiko für den Patienten beinhaltet. Malperfusion of the thoracoabdominal aorta and its side branches is a common complication of aortic dissection, often proving fatal. Vital organ malperfusion accompanying acute aortic dissection is a major cause of mortality and morbidity and requires timely reperfusion of the ischemic organs as well as adequate management of the aortic dissection. Ischemic damage to vital organs supplied by the thoracoabdominal aorta greatly increases the overall risk of aortic dissection. As initial symptoms may be subtle, malperfusion tends to be recognized late, and therefore accounts for a considerable percentage of fatalities. Effective reperfusion is not readily achieved by central aortic surgery alone in a certain number of patients. Various strategies have been used, including entry closure by central aortic surgery or stent grafting, surgical or catheter fenestration, bypass grafting and percutaneous stenting. Endovascular bare-metal stent placement is an attractive and promising treatment option since it is readily available, is less invasive and presents fewer risks to the patient. SchlüsselwörterMalperfusion–Reperfusion–Aortendissektion–Endovaskuläre Behandlung–Stent-Graft KeywordsMalperfusion–Reperfusion–Aortic dissection–Endovascular therapy–Stent graft
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