Das Poplitealarterienaneurysma – chirurgische und endovaskuläre Therapie

 

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Zusammenfassung

Erweiterungen der A. poplitea um mehr als 50 % des ursprünglichen Durchmessers werden als Poplitealarterienaneurysma bezeichnet. In mehr als 95 % der Fälle handelt es sich um arteriosklerotische Aneurysmen. Die Prävalenz asymptomatischer oder symptomatischer Poplitealarterienaneurysmen beträgt in der Gesamtbevölkerung < 0,5 % und steigt in der Altersgruppe der 65–80-Jährigen auf ca. 1 %. Bei einem Drittel aller diagnostizierten Poplitealarterienaneurysmen handelt es sich um asymptomatische Zufallsbefunde, während die anderen zwei Drittel aufgrund einer Symptomatik (akute oder chronische Ischämie, lokale Kompression, Ruptur) entdeckt werden. Die Indikation zu einer invasiven Therapieindikation besteht bei asymptomatischen Poplitealarterienaneurysmen ab einem Querdurchmesser von mehr als 2 cm. Symptomatische Poplitealarterienaneurysmen stellen immer eine Behandlungsindikation dar, wobei die akute und die chronische Ischämie mit ihrer hohen Morbidität im Vordergrund stehen. Zur Therapie stehen seit Mitte des letzten Jahrhunderts gefäßrekonstruktive Verfahren zur Verfügung, die auch heute noch den Goldstandard darstellen. Trotzdem kommen in letzter Zeit aber immer häufiger endovaskuläre Therapieformen zum Einsatz. In dieser Übersicht soll der derzeitige Kenntnisstand über Indikation, Eignung und Ergebnisse von chirurgischen und endovaskulären Verfahren zur Behandlung des Poplitealarterienaneurysmas dargestellt werden. 

Abstract

Popliteal artery aneurysm is defined as an enlargement of the popliteal artery of more than 50 % of the original diameter. In more than 95 % of the cases, arteriosclerosis is the cause. The prevalence of asymptomatic and symptomatic popliteal artery aneurysms is less than 0.5 % of the population but rises in the age group of the 65–80-year-olds up to 1 %. About one-third of all diagnosed popliteal artery aneurysms are asymptomatic incidental findings, whereas the other two-thirds are noticed due to their symptoms (acute or chronic ischaemia, local compression syndrome, rupture). The indication for invasive treatment is considered for asymptomatic popliteal artery aneurysms at a diameter of more than 2 cm. Symptomatic popliteal artery aneurysms are always an indication for treatment, but acute and chronic ischaemia is associated with a high morbidity. Since the middle of the last century surgical techniques have been used in the therapy for popliteal artery aneurysms and represent the gold standard in treatment strategies. Nevertheless, a growing number of reports about endovascular interventions for popliteal artery aneurysms are being published. In this review the state of knowledge about indications, applicability and results of invasive therapies for the treatment of popliteal artery aneurysms are presented. 

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Prof. Hans-Henning Eckstein

Klinikum rechts der Isar der Technischen Universität München · Klinik für Gefäßchirurgie

Ismaninger Str. 22

81675 München

Deutschland

Phone: 0 89 / 41 40 21 67

Fax: 0 89 / 41 40 49 61

Email: hheckstein@web.de