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Bildgebende Diagnostik und interventionelle Therapie bei arteriellen mesenterialen Durchblutungsstörungen

Imaging diagnostics and interventional therapy for arterial mesenteric circulatory disorders

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Zusammenfassung

Mesenteriale Durchblutungsstörungen werden in akute und chronische Verlaufsformen eingeteilt. Die Prognose der akuten Ischämie wird durch die rechtzeitige Diagnosestellung entscheidend beeinflusst. Die Katheterangiographie repräsentiert den Goldstandard in der Diagnostik, die Computertomographie spielt in der klinischen Routine eine immer wichtigere Rolle, da sie zum Ausschluss wichtiger Differenzialdiagnosen dient und die neuen Gerätegenerationen eine immer bessere Darstellung des Gefäßsystems ermöglichen. Die Therapie der Wahl ist die chirurgische Gefäßrekonstruktion und die Resektion ischämischer Darmabschnitte. Radiologisch-interventionelle Verfahren bleiben ausgewählten Patienten vorbehalten. Die Diagnostik der chronischen mesenterialen Ischämie erfolgt durch die Dopplersonographie und durch die CT- und MR-Angiographie. Therapeutisch treten die minimal-invasiven perkutanen Verfahren in den Vordergrund. Die Stentangioplastie der viszeralen Arterien kann mit einer technischen Erfolgsrate von über 90% durchgeführt werden. Obgleich die Dauer des symptomfreien Intervalls im Vergleich zu den operierten Patienten tendenziell etwas kürzer ist, besteht kein Unterschied beider Kollektive in Bezug auf die Überlebenszeit. Eine Verbesserung der Langzeitergebnisse ist durch die Optimierung der Pharmakotherapie und die modernen Implantate zu erwarten.

Abstract

Acute and a chronic mesenteric ischemia should be differentiated from one another. The prognosis for acute mesenteric ischemia is determined by early diagnosis and therapy. Conventional catheter angiography represents the gold standard in diagnosis. Computed tomography plays an increasingly important role in clinical routine due to the sectional image data it provides. This can exclude relevant differential diagnoses. Additionally, recently introduced advanced multislice scanners allow excellent image quality in CT angiography. The therapy of choice is surgical vessel reconstruction with resection of the ischemic bowel. Radiological intervention is employed in selected patients. The diagnosis of chronic mesenteric ischemic conditions is mainly performed by duplex ultrasound as well as CT and MR angiography. Percutaneously performed minimally invasive interventions have become more important in recent years. Stent application in visceral arteries is successful in over 90% of cases. Although the asymptomatic interval in patients treated with stents is slightly longer, there is no difference in survival time. Long-term improvement can be expected due to optimized pharmaceutical therapy as well as enhanced modern stents.

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Authors and Affiliations

  1. Institut für diagnostische und interventionelle Radiologie, Klinikum Weiden, Postfach 1860, 92608, Weiden

    C. Paetzel

  2. Institut für Röntgendiagnostik, Klinikum der Universität Regensburg

    S. Feuerbach, I. Kaempfe, P. Heiß, N. Zorger & T. Herold

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  1. C. Paetzel
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  2. S. Feuerbach
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  3. I. Kaempfe
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  4. P. Heiß
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  5. N. Zorger
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  6. T. Herold
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Correspondence to C. Paetzel.

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Paetzel, C., Feuerbach, S., Kaempfe, I. et al. Bildgebende Diagnostik und interventionelle Therapie bei arteriellen mesenterialen Durchblutungsstörungen. Gefässchirurgie 11, 159–166 (2006). https://doi.org/10.1007/s00772-006-0457-0

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  • DOI: https://doi.org/10.1007/s00772-006-0457-0

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