Kalder J, Kotelis D, Jacobs M J
Europäisches Gefäßzentrum Aachen Maastricht, Klinik für Gefäßchirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
Europäisches Gefäßzentrum Aachen Maastricht, Klinik für Gefäßchirurgie, Maastricht University Medical Center, Maastricht, Niederlande.
Chirurg. 2016 Sep;87(9):797-810. doi: 10.1007/s00104-016-0283-1.
Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results.
胸腹主动脉瘤（TAAA）较为罕见，年发病率为每10万人中有5.9例。在德国，每年大约进行940例TAAA手术。TAAA的病因大多是退行性的，但也可能基于主动脉夹层或结缔组织疾病（如马凡综合征）而发生。患者通常有严重的合并症，患有高血压、冠心病或慢性阻塞性肺疾病，这大多是吸烟所致。当主动脉最大直径达到6厘米（结缔组织疾病患者>5厘米）或主动脉直径迅速增加（>5毫米/年）时，需进行手术治疗。治疗选择包括体外循环下的开放手术主动脉修复、使用分支/开窗型腔内移植物和平行移植物（烟囱技术）的血管腔内修复或开放手术与血管腔内手术相结合（杂交手术）。根据修复范围，开放手术和血管腔内手术后的死亡率约为8%。此外，还存在诸如截瘫（高达20%）和透析必要性等相关并发症风险。近年来，已经提出了几种降低这些风险的方法。除了心肺风险评估外，医生对患者特定解剖结构的临床评估也会影响患者对一种或另一种治疗选择的分配。TAAA手术理想情况下应在高容量中心进行，以便取得更好的效果。
