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Multifokale arterielle Aneurysmen – eine eigene Entität?

Multifocal arterial aneurysms—An independent entity?

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Zusammenfassung

Hintergrund

Ätiologisch sind zahlreiche Ursachen für die Entstehung von arteriellen Aneurysmen bekannt. Die Entschlüsselung und Differenzierung der biologischen Prozesse ist eines der Kerngebiete in der Erforschung der Aneurysmaentstehung. Einige Patienten weisen mehrere arterielle Aneurysmen auf, ohne Nachweis einer syndromalen Bindegewebserkrankung. Die Erforschung dieses klinischen Phänomens könnte weitere Erkenntnisse in der Biologie vaskulärer Zellen aufzeigen. Die vorliegende Übersichtsarbeit hat zum Ziel anhand einer selektiven Literaturrecherche zu klären, ob eine weitergehende Erforschung von multifokalen arteriellen Aneurysmen (MAA) zur Klärung der Aneurysmagenese beitragen kann.

Methode

Es wurde eine Literaturrecherche in „PubMed“ durchgeführt, die einen Zeitraum von 1931 bis 2020 einschloss. Die Suche basiert auf englischsprachigen Fachbegriffen, die zur Beschreibung von multiplen arteriellen Aneurysmen eingesetzt werden: „multiple aneurysmal disease“, „arteriomegaly“, „mega aorta syndrom“, „diffuse aneurysmal disease“, „aneurysmosis“, „dilative aortopathy“, „dilative arteriopathy“, „etiology of multiple arterial aneurysms“

Resultat

Insgesamt wurden 291 Artikel ausgewertet. Es wurden 9 verschiedene Gefäßregionen mit multifokalem Auftreten von Aneurysmen identifiziert. Ätiologisch wurden 17 verschiedene Mechanismen gefunden wobei u. a. septische oder arteriosklerotische Komplikationen wie Plaquerupturen ausgeschlossen wurden.

Schlussfolgerung

Sowohl die Nomenklatur als auch deren Anwendung in der Literatur sind unklar und werden uneinheitlich eingesetzt. Behandlungsempfehlungen oder Algorithmen zur Diagnostik und Therapie können ebenso nicht einheitlich für MAA gestellt werden. Somit können MAA gegenwärtig nicht als einheitliche eigene Entität gewertet werden. Einzelne pathogenetische Mechanismen im Kontext der MAA rechtfertigen aber die Erforschung dieser Hypothese und bergen das Potenzial, die Bewertung von MAA als eigenständige Krankheitsentität zuzulassen.

Abstract

Background

Many etiological reasons for the formation of arterial aneurysms are known. The decoding and differentiation of the biological process is a central topic in the research of formation of aneurysms. Some patients have several arterial aneurysms with no evidence of a syndromic connective tissue disease. The investigation of this clinical phenomenon could bring further knowledge of the biology of vascular cells. Based on a selective literature search the aim of this review article is to clarify whether an extended investigation of multifocal arterial aneurysms (MAA) can contribute to the clarification of the genesis of aneurysms.

Method

A literature search was carried out in PubMed for the time period 1931–2020. The search was based on the following English medical terms used to describe MAA: multiple aneurysmal disease, arteriomegaly, mega aorta syndrome, diffuse aneurysmal disease, aneurysmosis, dilative aortopathy, dilative arteriopathy, etiology of multiple arterial aneurysms.

Results

A total of 291 articles were assessed and 9 different vascular regions with a multifocal occurrence of aneurysms were identified. Etiologically, 17 different mechanisms were found, whereby septic and arteriosclerotic complications, such as plaque ruptures were excluded.

Conclusion

The nomenclature and the utilization in the literature are unclear and not uniformly applied. Recommendations and algorithms for the diagnostics and treatment of MAA can also not be uniformly made. Therefore, MAA cannot currently be assessed as a uniform single entity. Isolated pathogenetic mechanisms in the context of MAA justify the investigation of this hypothesis and have the potential to enable the evaluation of MAA as an independent disease entity.

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  1. Klinik für Gefässchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6004, Luzern, Schweiz

    M. Hakimi, A. Leiser, U. Wenger, A. Stellmes & R. Seelos

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M. Hakimi, A. Leiser, U. Wenger, A. Stellmes und R. Seelos geben an, dass kein Interessenkonflikt besteht.

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Hakimi, M., Leiser, A., Wenger, U. et al. Multifokale arterielle Aneurysmen – eine eigene Entität?. Gefässchirurgie 25, 256–266 (2020). https://doi.org/10.1007/s00772-020-00653-0

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