Advertisement

Aortentherapie interdisziplinär: das A-Team

  • J. Haunschild
  • K. von Aspern
  • D. Scheinert
  • A. Schmidt
  • M. A. Borger
  • C. D. EtzEmail author
Karriere und Perspektiven
  • 10 Downloads

Zusammenfassung

Aufgrund verbesserter Notfallversorgung und progressiver angewandter Diagnostik wächst die Zahl an Patienten mit (meist symptomfreien) gesicherten pathologischen Aortenveränderungen stetig. Nicht selten überschreiten multisegmentale Aortenaneurysmata traditionelle „Fachgebietsgrenzen“; folglich ist die fachübergreifende Betreuung durch ein erfahrenes, interdisziplinäres Expertenteam zukunftweisend. Nur so kommen optimale, oft individuell „maßgeschneiderte“ – und mit internationalem „State of the Art“ abgeglichene – Therapiekonzepte zum Einsatz am Patienten. Sowohl die Kenntnis des chirurgischen und des interventionellen Goldstandards sowie auch neuester technischer Modifikationen und Verbesserungen von Stents und Prothesen gehören zu den Grundkenntnissen des Aortenexperten, die in diesem Gebiet, das einer enormen Entwicklung unterworfen ist, der ständigen Aktualisierung bedürfen. Da die Herz- und Gefäßchirurgie sowie die Angiologie sich immer weiter annähern, sollte die Therapie dieser Patienten mit komplexen Störungen gemeinsam im interdisziplinären Team diskutiert werden. Der vorliegende Beitrag bietet einen Überblick über aktuelle Behandlungsalgorithmen, chirurgische und interventionelle Therapieoptionen, einige etablierte deutsche Aortenzentren sowie Fort- und Weiterbildungsmöglichkeiten für den angehenden Aortenexperten.

Schlüsselwörter

Aortenaneurysma Aortendissektion Patientenversorgung Professionelle Kompetenz Aortenzentrum 

Interdisciplinary treatment of aortic diseases: the A-team

Abstract

Due to improvements in emergency care and the progressive diagnostics applied, the number of patients with (mostly asymptomatic) confirmed pathological alterations of the aorta is continuously increasing. It is not uncommon for aortic aneurysms that extend over several segments to cross traditional borders between medical disciplines. This results in a trendsetting cross-sectoral care by an experienced interdisciplinary team of experts. This is the only way that optimal, often individually tailored and internationally comparable state of the art treatment concepts can be implemented for patients. Knowledge of the surgical and interventional gold standards as well as the most recent technical modifications and improvements in stents and prostheses are part of the fundamental knowledge of experts in the field of aortic diseases. This field is subject to an enormous development and continuous updating is necessary. As the treatment of patients with aortic diseases is complex and the demarcation between cardiac and vascular surgery as well as angiology is becoming less distinct, the treatment of these patients should be the subject of joint discussions in an interdisciplinary team. This article provides an overview on contemporary treatment algorithms, modern surgical and interventional treatment options, some established centers for aortic diseases in Germany as well as possibilities for training and advanced education to develop the specialists for aortic diseases needed in the future.

Keywords

Aortic aneurysm Aortic dissection Patient care Professional competence Aortic center 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Haunschild, K. von Aspern, D. Scheinert, A. Schmidt, M.A. Borger und C.D. Etz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Statistisches Bundesamt (2019) Webpräsenz. https://www.destatis.de/DE/Startseite.html. Zugegriffen: März 2019Google Scholar
  2. 2.
    Kantonen I et al (1997) Mortality in abdominal aortic aneurysm surgery—the effect of hospital volume, patient mix and surgeon’s case load. Eur J Vasc Endovasc Surg 14(5):375–379CrossRefGoogle Scholar
  3. 3.
    Dimick JB et al (2003) Surgeon specialty and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States. J Vasc Surg 38(4):739–744CrossRefGoogle Scholar
  4. 4.
    Zdanowski Z et al (2002) Outcome of treatment of ruptured abdominal aortic aneurysms depending on the type of hospital. Eur J Surg 168(2):96–100CrossRefGoogle Scholar
  5. 5.
    Umana-Pizano JB et al (2019) Acute type A dissection repair by high versus low volume surgeons at a high-volume aortic center. Ann Thorac Surg.  https://doi.org/10.1016/j.athoracsur.2019.04.040 CrossRefPubMedGoogle Scholar
  6. 6.
    Debakey ME et al (1965) Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 49:130–149PubMedGoogle Scholar
  7. 7.
    Erbel R et al (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 35(41):2873–2926CrossRefGoogle Scholar
  8. 8.
    Yuan X et al (2019) The IRAD and beyond: what have we unravelled so far? Gen Thorac Cardiovasc Surg 67(1):146–153CrossRefGoogle Scholar
  9. 9.
    Bouziane Z et al (2019) Endovascular treatment of aortic arch vessels stents migration: 3 case reports. Ann Vasc Surg.  https://doi.org/10.1016/j.avsg.2019.01.029 CrossRefPubMedGoogle Scholar
  10. 10.
    Kopp R et al (2019) Multicenter analysis of endovascular aortic arch in situ stent graft fenestrations for aortic arch pathologies. Ann Vasc Surg.  https://doi.org/10.1016/j.avsg.2019.02.005 CrossRefPubMedGoogle Scholar
  11. 11.
    Law Y et al (2018) Emergency use of branched thoracic endovascular repair in the treatment of aortic arch pathologies. Ann Thorac Surg.  https://doi.org/10.1016/j.athoracsur.2018.09.020 CrossRefPubMedGoogle Scholar
  12. 12.
    Greiner A, Jacobs MJ (2012) Aortenzentren. Gefäßchirurgie.  https://doi.org/10.1007/s00772-012-1044-1 CrossRefGoogle Scholar
  13. 13.
    Dake MD et al (2013) DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg 46(2):175–190CrossRefGoogle Scholar
  14. 14.
    Kurz SD et al (2017) Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg. Int J Cardiol 241:326–329CrossRefGoogle Scholar
  15. 15.
    Lee TC, Kon Z, Cheema FH, Grau-Sepulveda MV, Englum B, Kim S et al (2018) Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STSadult cardiac surgery database. J Card Surg 33(1):7–18.  https://doi.org/10.1111/jocs.13511. Epub 2018 Jan 4CrossRefPubMedGoogle Scholar
  16. 16.
    Pape LA et al (2015) Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol 66(4):350–358CrossRefGoogle Scholar
  17. 17.
    Kimura N et al (2014) Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection. Am J Cardiol 113(4):724–730CrossRefGoogle Scholar
  18. 18.
    Berretta P et al (2016) IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg 5(4):346–351CrossRefGoogle Scholar
  19. 19.
    Zimpfer D et al (2006) Treatment of acute type a dissection by percutaneous endovascular stent-graft placement. Ann Thorac Surg 82(2):747–749CrossRefGoogle Scholar
  20. 20.
    Baikoussis NG et al (2017) Endovascular stent grafting for ascending aorta diseases. J Vasc Surg 66(5):1587–1601CrossRefGoogle Scholar
  21. 21.
    Grieshaber P et al (2018) Endovascular treatment of the ascending aorta using a combined transapical and transfemoral approach. J Vasc Surg 67(2):649–655CrossRefGoogle Scholar
  22. 22.
    Kolbel T et al (2017) Acute type A aortic dissection treated using a tubular stent-graft in the ascending aorta and a multibranched stent-graft in the aortic arch. J Endovasc Ther 24(1):75–80CrossRefGoogle Scholar
  23. 23.
    Rylski B et al (2014) Development of a single endovascular device for aortic valve replacement and ascending aortic repair. J Card Surg 29(3):371–376CrossRefGoogle Scholar
  24. 24.
    Kreibich M et al (2018) Endovascular treatment of acute type A aortic dissection-the endo Bentall approach. J Vis Surg 4:69CrossRefGoogle Scholar
  25. 25.
    Prabhakar AM et al (2015) Incidental findings and recommendations are common on ED CT angiography to evaluate for aortic dissection. Am J Emerg Med 33(11):1639–1641CrossRefGoogle Scholar
  26. 26.
    Khashram M, Jones GT, Roake JA (2015) Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. Eur J Vasc Endovasc Surg 50(2):199–205CrossRefGoogle Scholar
  27. 27.
    Radtke R (2019) Anzahl von Computertomographen in ausgewählten Ländern Europas im Jahr 2016 (je Million Einwohner). https://de.statista.com/statistik/daten/studie/182666/umfrage/computertomographen-anzahl-in-europa/. Zugegriffen: Mai 2019Google Scholar
  28. 28.
    Park SW et al (2004) Association of painless acute aortic dissection with increased mortality. Mayo Clin Proc 79(10):1252–1257CrossRefGoogle Scholar
  29. 29.
    Upchurch GR Jr et al (2005) Acute aortic dissection presenting with primarily abdominal pain: a rare manifestation of a deadly disease. Ann Vasc Surg 19(3):367–373CrossRefGoogle Scholar
  30. 30.
    Patel NY, Riherd JM (2011) Focused assessment with sonography for trauma: methods, accuracy, and indications. Surg Clin North Am 91(1):195–207CrossRefGoogle Scholar
  31. 31.
    Harris KM et al (2011) Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation 124(18):1911–1918CrossRefGoogle Scholar
  32. 32.
    Raghupathy A et al (2008) Geographic differences in clinical presentation, treatment, and outcomes in type A acute aortic dissection (from the International Registry of Acute Aortic Dissection). Am J Cardiol 102(11):1562–1566CrossRefGoogle Scholar
  33. 33.
    Adnet F et al (2011) Incidence of acute myocardial infarction resulting in sudden death outside the hospital. Emerg Med J 28(10):884–886CrossRefGoogle Scholar
  34. 34.
    Nienaber CA, von Kodolitsch Y (1992) Meta-analysis of the prognosis of thoracic aortic dissection: changing mortality in the last four decades. Herz 17(6):398–416PubMedGoogle Scholar
  35. 35.
    Luebke T, Brunkwall J (2010) Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: a systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino) 51(5):613–632Google Scholar
  36. 36.
    Pasta S et al (2012) Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. J Thorac Cardiovasc Surg 143(2):460–467CrossRefGoogle Scholar
  37. 37.
    Olsson C et al (2006) Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 114(24):2611–2618CrossRefGoogle Scholar
  38. 38.
    Meszaros I et al (2000) Epidemiology and clinicopathology of aortic dissection. Chest 117(5):1271–1278CrossRefGoogle Scholar
  39. 39.
    Maier C (2017) Berliner Konzept rettet Patienten mit Aortendissektion das Leben. https://www.aerztezeitung.de/medizin/krankheiten/herzkreislauf/article/942678/berliner-konzept-aortentelefon-wenn-arterienwand-aufreisst.html. Zugegriffen: Mai 2019Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • J. Haunschild
    • 1
  • K. von Aspern
    • 1
  • D. Scheinert
    • 2
  • A. Schmidt
    • 2
  • M. A. Borger
    • 1
  • C. D. Etz
    • 1
    Email author
  1. 1.Universitätsklinik für HerzchirurgieHerzzentrum LeipzigLeipzigDeutschland
  2. 2.Klinik und Poliklinik für AngiologieUniversitätsklinikum LeipzigLeipzigDeutschland

Personalised recommendations