Baumann F, Makaloski V, Diehm N
Schweizerisches Herz- und Gefässzentrum, Abteilung für Klinische und Interventionelle Angiologie, Inselspital, Universität Bern, Freiburgstr., 3010 Bern, Schweiz.
Internist (Berl). 2013 May;54(5):535-42. doi: 10.1007/s00108-012-3217-0.
Aortic aneurysms and aortic dissection represent a significant health risk due to the demographic developments and current life styles. The mortality of ruptured aortic aneurysms is up to 80 % and the prevalence of aneurysms varies depending on the localization (thoracic or abdominal). Most commonly affected is the infrarenal abdominal aorta; however, there is evidence that the prevalence is diminishing but in contrast the incidence of thoracic aortic aneurysms is increasing. Aortic dissection is often fatal and is the most common acute aortic disease but the incidence is presumed to be underestimated. The pathogenesis of aortic aneurysms is manifold and is based on an interplay between degenerative, proteolytic and inflammatory processes. An aortic dissection arises from a tear in the intima which results in a separation of the aortic wall layers with infiltration of bleeding and the danger of aortic rupture. Various genetic disorders of connective tissue promote degeneration of the aortic media, most notably Marfan syndrome. Risk factors for aortic aneurysms and aortic dissection are nicotine abuse, arterial hypertension, age and male gender. Aortic aneurysms initially have an uneventful course and as a consequence are mostly discovered incidentally. The clinical course and symptoms of aortic dissection are very much dependent on the section of the aorta affected and the manifestations are manifold. Acute aortic dissection is in 80 % of cases first manifested as sudden extremely severe pain. The diagnostics and subsequent course control can be achieved by a variety of imaging procedures but the modality of choice is computed tomography.
由于人口结构变化和当前生活方式，主动脉瘤和主动脉夹层构成了重大的健康风险。破裂性主动脉瘤的死亡率高达80%，动脉瘤的患病率因部位（胸段或腹段）而异。最常受累的是肾下腹主动脉；然而，有证据表明其患病率正在下降，但相比之下，胸主动脉瘤的发病率正在上升。主动脉夹层通常是致命的，是最常见的急性主动脉疾病，但据推测其发病率被低估了。主动脉瘤的发病机制是多方面的，基于退行性、蛋白水解和炎症过程之间的相互作用。主动脉夹层源于内膜撕裂，导致主动脉壁各层分离，伴有出血浸润和主动脉破裂的危险。各种结缔组织遗传性疾病会促进主动脉中膜退变，最显著的是马凡综合征。主动脉瘤和主动脉夹层的危险因素包括吸烟、动脉高血压、年龄和男性性别。主动脉瘤最初病程平稳，因此大多是偶然发现的。主动脉夹层的临床病程和症状在很大程度上取决于受影响的主动脉节段，表现多种多样。80%的急性主动脉夹层病例最初表现为突然发作的极其剧烈的疼痛。通过多种成像检查可以实现诊断和后续病程监测，但首选的检查方式是计算机断层扫描。
