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Aortale Dissektion (S2)

Leitlinie zur Diagnostik und Therapie von Typ-B-Dissektionen

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Leitlinien zu Diagnostik und Therapie in der Gefäßchirurgie

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Zusammenfassung

Das akute Aortensyndrom umfasst neben der Erkrankung der Aortendissektion das intramurale Hämatom (IMH) und das symptomatische penetrierende Aortenulkus (PAU).

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Literatur

  1. Daily PO et al., Management of acute aortic dissections. Ann Thorac Surg (1970), 10, 237–247

    CAS  PubMed  Google Scholar 

  2. DeBakey ME et al., Surgical Management of Dissecting Aneurysms of the Aorta. J Thorac Cardiovasc Surg (1965), 49, 130–149

    CAS  PubMed  Google Scholar 

  3. Svensson LG et al., Intimal Tear Without Hematoma: An Important Variant of Aortic Dissection That Can Elude Current Imaging Techniques. Circulation (1999), 99, 1331–1336

    CAS  PubMed  Google Scholar 

  4. Meszaros I et al., Epidemiology and clinicopathology of aortic dissection. Chest (2000), 117, 1271–1278

    Article  CAS  PubMed  Google Scholar 

  5. Spittell PC et al., Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clinic proceedings (1993), 68, 642–651

    CAS  PubMed  Google Scholar 

  6. Hirst AE Jr, Johns VJ Jr, Kime SW Jr, Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) (1958), 37, 217–279

    Google Scholar 

  7. Hagan PG et al., The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA (2000), 283, 897–903

    Article  CAS  PubMed  Google Scholar 

  8. Mehta RH et al., The winter peak in the occurrence of acute aortic dissection is independent of climate. Chronobiol Int (2005), 22, 723–729

    Article  PubMed  Google Scholar 

  9. Mehta RH et al., Does circadian and seasonal variation in occurrence of acute aortic dissection influence in-hospital outcomes? Chronobiol Int (2005), 22, 343–351

    Article  PubMed  Google Scholar 

  10. Mehta RH et al., Chronobiological patterns of acute aortic dissection. Circulation (2002), 106, 1110–1115

    Article  PubMed  Google Scholar 

  11. Wilson SK, Hutchins GM, Aortic dissecting aneurysms: causative factors in 204 subjects. Arch Pathol Lab Med (1982), 106, 175–180

    CAS  PubMed  Google Scholar 

  12. Erbel R, General Cardiology: Diseases of the thoracic aorta. Heart (2001), 86, 227–234

    Article  CAS  PubMed  Google Scholar 

  13. Wheat MW Jr, Palmer RF, Dissecting aneurysms of the aorta: present status of drug versus surgical therapy. Prog Cardiovasc Dis (1968), 11, 198–210

    Article  PubMed  Google Scholar 

  14. Khan IA, Nair CK, Clinical, diagnostic, and management perspectives of aortic dissection. Chest (2002), 122, 311–328

    Article  PubMed  Google Scholar 

  15. Lesauskaite V et al. Smooth muscle cells of the media in the dilatative pathology of ascending thoracic aorta: morphology, immunoreactivity for osteopontin, matrix metalloproteinases, and their inhibitors. Hum Pathol (2001), 32, 1003–1011

    Article  CAS  PubMed  Google Scholar 

  16. Marsalese DL et al., Cystic medial necrosis of the aorta in patients without Marfan’s syndrome: surgical outcome and long-term follow-up. J Am Coll Cardiol (1990), 16, 68–73

    CAS  PubMed  Google Scholar 

  17. Jex RK et al., Early and late results following repair of dissections of the descending thoracic aorta. J Vasc Surg (1986), 3, 226–237

    Article  CAS  PubMed  Google Scholar 

  18. Cambria RP et al., Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg (1988), 208, 619–624

    Article  CAS  PubMed  Google Scholar 

  19. von Kodolitsch Y et al., Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation (2003), 107, 1158–1163

    Article  Google Scholar 

  20. Cambria RP, Regarding Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography. J Vasc Surg (2002), 35, 1295–1296

    PubMed  Google Scholar 

  21. Stanson AW et al., Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg (1986), 1, 15–23

    CAS  PubMed  Google Scholar 

  22. Sueyoshi E et al., Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography. J Vasc Surg (2002), 35, 1179–1183

    Article  PubMed  Google Scholar 

  23. Muluk SC et al., Diagnosis and treatment of thoracic aortic intramural hematoma. J Vasc Surg (1996), 24, 1022–1029

    Article  CAS  PubMed  Google Scholar 

  24. Ohmi M et al., Extremely rapid regression of aortic intramural hematoma. J Thorac Cardiovasc Surg (1999), 118, 968–969

    Article  CAS  PubMed  Google Scholar 

  25. Coady MA et al., Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg (1998), 27, 1006–1015

    Article  CAS  PubMed  Google Scholar 

  26. Januzzi JL et al., Significance of recurrent pain in acute type B aortic dissection. Am J Cardiol (2001), 87, 930–933

    Article  CAS  PubMed  Google Scholar 

  27. Nallamothu BK et al., Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications. Am J Med (2002), 113, 468–471

    Article  PubMed  Google Scholar 

  28. Sanders JS, Ferguson DW, Mark AL, Arterial baroreflex control of sympathetic nerve activity during elevation of blood pressure in normal man: dominance of aortic baroreflexes. Circulation (1988), 77, 279–288

    CAS  PubMed  Google Scholar 

  29. Syed MA, Fiad TM, Transient paraplegia as a presenting feature of aortic dissection in a young man. Emerg Med J (2002), 19, 174–175

    Article  CAS  PubMed  Google Scholar 

  30. Januzzi JL et al., Refractory systemic hypertension following type B aortic dissection. Am J Cardiol (2001), 88, 686–688

    Article  CAS  PubMed  Google Scholar 

  31. Cambria RP et al., Vascular complications associated with spontaneous aortic dissection. J Vasc Surg (1988), 7, 199–209

    Article  CAS  PubMed  Google Scholar 

  32. DeBakey ME et al., Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery (1982), 92, 1118–1134

    CAS  PubMed  Google Scholar 

  33. Fann JI et al. Surgical management of aortic dissection during a 30-year period. Circulation (1995), 92, II113–II121

    CAS  PubMed  Google Scholar 

  34. Bossone E et al., Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol (2002), 89, 851–855

    Article  PubMed  Google Scholar 

  35. von Kodolitsch Y, Schwartz AG, Nienaber CA, Clinical prediction of acute aortic dissection. Arch Intern Med (2000), 160, 2977–2982

    Article  Google Scholar 

  36. von Kodolitsch Y et al., Chest radiography for the diagnosis of acute aortic syndrome. Am J Med (2004), 116, 73–77

    Article  Google Scholar 

  37. Hata N et al., Clinical significance of pleural effusion in acute aortic dissection. Chest (2002), 121, 825–830

    Article  PubMed  Google Scholar 

  38. Dinsmore RE et al., MRI of dissection of the aorta: recognition of the intimal tear and differential flow velocities. AJR Am J Radiol (1986), 146, 1286–1288

    CAS  Google Scholar 

  39. Guthaner DF, Miller DC, Digital subtraction angiography of aortic dissection. AJR Am J Radiol (1983), 141, 157–161

    CAS  Google Scholar 

  40. Petasnick JP, Radiologic evaluation of aortic dissection. Radiology (1991), 180, 297–305

    CAS  PubMed  Google Scholar 

  41. Earnest Ft, Muhm JR, Sheedy PF, 2nd. Roentgenographic findings in thoracic aortic dissection. Mayo Clinic proceedings (1979), 54, 43–50

    PubMed  Google Scholar 

  42. Mugge A et al., False-negative diagnosis of proximal aortic dissection by computed tomography or angiography and possible explanations based on transesophageal echocardiographic findings. Am J Cardiol 1990, 65, 527–529

    Article  CAS  PubMed  Google Scholar 

  43. Rizzo RJ et al., Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection. Improved survival with less angiography. JThorac Cardiovasc Surg (1994), 108, 567–574 (disc. 574–565)

    CAS  Google Scholar 

  44. Erbel R et al. Echocardiography in diagnosis of aortic dissection. Lancet (1989), 1, 457–461

    Article  CAS  PubMed  Google Scholar 

  45. Victor MF et al., Two dimensional echocardiographic diagnosis of aortic dissection. Am J Cardiol (1981), 48, 1155–1159

    Article  CAS  PubMed  Google Scholar 

  46. Keren A, Kim CB, Hu BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol (1996), 28, 627–636

    Article  CAS  PubMed  Google Scholar 

  47. Vignon P et al. Differential transesophageal echocardiographic diagnosis between linear artifacts and intraluminal flap of aortic dissection or disruption. Chest (2001), 119, 1778–1790

    Article  CAS  PubMed  Google Scholar 

  48. Bansal RC et al., Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol (1995), 25, 1393–1401

    Article  CAS  PubMed  Google Scholar 

  49. Erbel R et al., Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study. Circulation (1990), 81, 805–814

    CAS  PubMed  Google Scholar 

  50. Mohr-Kahaly S et al., Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography. Circulation (1989), 80, 24–33

    CAS  PubMed  Google Scholar 

  51. Fruehwald FX et al., Cine-MR in dissection of the thoracic aorta. Eur J Radiol (1989), 9, 37–41

    CAS  PubMed  Google Scholar 

  52. Moore AG et al., Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol (2002), 89, 1235–1238

    Article  PubMed  Google Scholar 

  53. Tomiguchi S et al., Usefulness of turbo-FLASH dynamic MR imaging of dissecting aneurysms of the thoracic aorta. Cardiovasc Intervent Radiol (1994), 17, 17–21

    Article  CAS  PubMed  Google Scholar 

  54. Prince MR et al., Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR Am J Radiol (1996), 166, 1387–1397

    CAS  Google Scholar 

  55. Clague J, Magee P, Mills P, Diagnostic techniques in suspected thoracic aortic dissection. British Heart Journal (1992), 67, 428–429

    Article  CAS  PubMed  Google Scholar 

  56. Fisher ER et al., Acute aortic dissection: typical and atypical imaging features. Radiographics (1994), 14, 1263–1271 (disc. 1271–1264)

    CAS  PubMed  Google Scholar 

  57. Hartnell G, Costello P, The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med (1993), 328, 1637–1638

    Article  CAS  PubMed  Google Scholar 

  58. Nienaber CA, von Kodolitsch Y, Diagnostic imaging of aortic diseases. Der Radiologe (1997), 37, 402–409

    Article  CAS  PubMed  Google Scholar 

  59. Sommer T et al., Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology (1996), 199, 347–352

    CAS  PubMed  Google Scholar 

  60. LePage MA et al., Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Radiol (2001), 177, 207–211

    CAS  Google Scholar 

  61. Suzuki T et al., Novel biochemical diagnostic method for aortic dissection. Results of a prospective study using an immunoassay of smooth muscle myosin heavy chain. Circulation (1996), 93, 1244–1249

    CAS  PubMed  Google Scholar 

  62. Eggebrecht H et al., Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol (2004), 44, 804–809

    Article  CAS  PubMed  Google Scholar 

  63. Shinohara T et al., Soluble elastin fragments in serum are elevated in acute aortic dissection. Arteriosclerosis, thrombosis, and vascular biology (2003), 23, 1839–1844

    Article  CAS  PubMed  Google Scholar 

  64. Erbel R et al., Diagnosis and management of aortic dissection. Eur Heart J (2001), 22, 1642–1681

    Article  CAS  PubMed  Google Scholar 

  65. Apaydin AZ et al., Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Vasc Surg (2002), 74, 2034–2039

    Google Scholar 

  66. Estrera AL et al., Is acute type A aortic dissection a true surgical emergency? Sem Vasc Surg (2002), 15, 75–82

    Article  Google Scholar 

  67. Lai DT et al., Does profound hypothermic circulatory arrest improve survival in patients with acute type a aortic dissection? Circulation (2002), 106, I218–I228

    PubMed  Google Scholar 

  68. Lansman SL et al., Acute type B aortic dissection: surgical therapy. AnnThorac Surg (2002), 74, S1833–S1835 (disc. 1857–1863)

    Article  Google Scholar 

  69. Sasaki S et al., Surgical results of Stanford type B aortic dissection. Comparisons between partial and subtotal replacement of the dissected aorta. J Cardiovasc Surg (2000), 41, 227–232

    CAS  Google Scholar 

  70. Neya K et al., Outcome of Stanford type B acute aortic dissection. Circulation (1992), 86, II1–II7

    CAS  PubMed  Google Scholar 

  71. Svensson LG et al., Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation (1990), 82, IV24–IV38

    CAS  PubMed  Google Scholar 

  72. Svensson LG et al., Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg (2008), 85, S1–S41

    Article  PubMed  Google Scholar 

  73. Dake MD et al., Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med (1999), 340, 1546–1552

    Article  CAS  PubMed  Google Scholar 

  74. Nienaber CA et al., Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med (1999), 340, 1539–1545

    Article  CAS  PubMed  Google Scholar 

  75. Nienaber CA et al., INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial — a prospective, multicenter, European randomized trial. Am Heart J (2005), 149, 592–599

    Article  PubMed  Google Scholar 

  76. Fattori R et al., Results of endovascular repair of the thoracic aorta with theTalent Thoracic stent graft: the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg (2006), 132, 332–339

    Article  PubMed  Google Scholar 

  77. Umana JP et al., Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dis-sections? J Thorac Cardiovasc Surg (2002), 124, 896–910

    Article  PubMed  Google Scholar 

  78. Umana JP, Miller DC, Mitchell RS, What is the best treatment for patients with acute type B aortic dissections — medical, surgical, or endovascular stent-grafting? Ann Thorac Surg (2002), 74, S1840–S1843 (disc. 1857–1863)

    Article  PubMed  Google Scholar 

  79. Clair DG, Aortic dissection with branch vessel occlusion: percutaneous treatment with fenestration and stenting. Semin Vasc Surg (2002), 15, 116–121

    Article  PubMed  Google Scholar 

  80. Elefteriades JA et al., Fenestration revisited. A safe and effective procedure for descending aortic dissection. Arch Surg (1990), 125, 786–790

    CAS  PubMed  Google Scholar 

  81. Laas J et al., Management of thoracoabdominal malperfusion in aortic dissection. Circulation (1991), 84, III20–III24

    CAS  PubMed  Google Scholar 

  82. Elefteriades JA et al., Long-term experience with descending aortic dissection: the complication-specific approach. Ann Thorac Surg (1992), 53, 11–20

    Article  CAS  PubMed  Google Scholar 

  83. Slonim SM et al., Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg (1999), 117, 1118–1126

    Article  CAS  PubMed  Google Scholar 

  84. Slonim SM et al., Aortic dissection: percutaneous management of ischemic complications with endovascular stentsand balloon fenestration. J Vasc Surg (1996), 23, 241–251 (disc. 251–243)

    Article  CAS  PubMed  Google Scholar 

  85. Williams DM, Brothers TE, Messina LM, Relief of mesenteric ischemia in type III aortic dissection with percutaneous fenestration of the aortic septum. Radiology (1990), 174, 450–452

    CAS  PubMed  Google Scholar 

  86. Williams DM et al., The dissected aorta: percutaneous treatment of ischemic complications—principles and results. J Vasc Interv Radiol (1997), 8, 605–625

    Article  CAS  PubMed  Google Scholar 

  87. Chung JW et al., True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow. Radiology (2000), 214, 99–106

    CAS  PubMed  Google Scholar 

  88. Chung JW et al., True-lumen collapse in aortic dissection: part I. Evaluation of causative factors in phantoms with pulsatile flow. Radiology (2000), 214, 87–98

    CAS  PubMed  Google Scholar 

  89. Lee DY, Williams DM, Abrams GD. The dissected aorta: part II. Differentiation of the true from the false lumen with intravascular US. Radiology 1997, 203, 32–36

    CAS  PubMed  Google Scholar 

  90. Hara K et al., The role of medical treatment of distal type aortic dissection. Int J Cardiol (1991), 32, 231–240

    Article  CAS  PubMed  Google Scholar 

  91. Tsai TT et al., Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med (2007), 357, 349–359

    Article  CAS  PubMed  Google Scholar 

  92. Marui A et al., Toward the best treatment for uncomplicated patients with type B acute aortic dissection, A consideration for sound surgical indication. Circulation (1999), 100, II275–II280

    CAS  PubMed  Google Scholar 

  93. Panneton JM, Hollier LH, Dissecting descending thoracic and thoracoabdominal aortic aneurysms: Part II. Ann Vasc Surg (1995), 9, 596–605

    Article  CAS  PubMed  Google Scholar 

  94. Bernard Y et al., False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol (2001), 87, 1378–1382

    Article  CAS  PubMed  Google Scholar 

  95. Juvonen T et al., Risk factors for rupture of chronic type B dissections. J Thorac Cardiovasc Surg (1999), 117, 776–786

    Article  CAS  PubMed  Google Scholar 

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    Deutsche Gesellschaft für Gefäßchirurgie. (2010). Aortale Dissektion (S2). In: Leitlinien zu Diagnostik und Therapie in der Gefäßchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-04710-7_4

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