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„Standard operating procedures“ zur Diagnostik und Therapie des akuten Aortensyndroms

Standard operating procedures for diagnostic assessment and therapeutic strategies of acute aortic syndromes

  • Interventionelle Kardiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Das akute Aortensyndrom (AAS) ist mit einer hohen Morbiditäts- und Mortalitätsrate insbesondere in der Initialphase der Erkrankung verbunden. Die rechtzeitige Diagnosestellung und die sich hieraus ableitende Therapie sind als Hauptfaktoren zur Verbesserung der Prognose anzusehen. Der Prozess der Diagnosefindung und Therapieplanung wird in Form einer erweiterten Ereignisprozesskette (eEPK) visuell dargestellt. An entscheidenden Prozessschritten der eEPK sind Handlungsanweisungen in Form von „standard operating procedures“ (SOPs) hinterlegt. Anhand von Risikofaktoren für das Vorliegen eines AAS erfolgt die initiale Bewertung und Einteilung in eine Hochrisiko- und eine Nicht-Hochrisikogruppe. Patienten der Hochrisikogruppe benötigen umgehend eine Bildgebung der Aorta. Patienten der Nicht-Hochrisikogruppe erhalten zunächst eine Basisdiagnostik. Die weiteren diagnostischen Schritte werden bei diesen Patienten in einer zweiten Risikostratifizierung zur Indikationsprüfung einer Bildgebung der Aorta geregelt. Sobald die Diagnose einer Aortendissektion gestellt wird, erfolgt in Abhängigkeit der Lokalisation die Einteilung nach der Stanford-Klassifikation. Hieraus leiten sich die weiteren therapeutischen Schritte ab. Patienten mit einer Typ-A-Aortendissektion werden primär operiert, wohingegen Patienten mit einer Typ-B-Dissektion primär konservativ therapiert werden.

Abstract

Acute aortic syndrome (AAS) describes a life threatening condition. Mortality rates in the initial phase remain high. Early diagnosis and therapy are essential to improving prognosis in these patients. Based on an advanced event-driven process chain (EPC) which addresses the diagnostic process as well as the therapy strategies for patients with AAS, standard operating procedures (SOPs) were developed. An estimation of pre-test risk of thoracic aortic dissection (AoD) is done by determination of risk factors that are associated with an AoD. Expedited aortic imaging is recommended to identify or exclude AoD in patients at high risk for the disease. For patients in the non-high risk group further diagnostic evaluation is necessary. In these patients a second risk-evaluation is done to indicate the need for urgent aortic imaging. After the diagnosis of an AoD could be made therapeutic strategies are based on the Stanford classification. AoD involving the ascending aorta (Stanford A) should be urgently evaluated for emergent surgical repair whereas AoD involving the descending aorta (Stanford B) should be managed medically unless life-threatening complications develop.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Leick, C. Hamm, A. Böning, J. Vollert, P. Radke und M. Möckel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung Kardiologie, Herz- und Thoraxzentrum, Kerckhoff-Klinik GmbH, Benekestr. 2–8, 61231, Bad Nauheim, Deutschland

    J. Leick & C. Hamm

  2. Medizinische Klinik I, Universitätsklinikum Gießen, Gießen, Deutschland

    C. Hamm

  3. Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland

    A. Böning

  4. Medizinische Klinik m. S. Kardiologie – Arbeitsbereich Notfallmedizin/Rettungsstellen mit CPU, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland

    J. Vollert & M. Möckel

  5. Kardiologie, Schön Klinik Neustadt, Neustadt, Deutschland

    P. Radke

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  1. J. Leick
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  2. C. Hamm
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  4. J. Vollert
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  5. P. Radke
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  6. M. Möckel
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Task Force „Patientenpfade“ der Deutschen Gesellschaft für Kardiologie - Herz- Kreislaufforschung

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Correspondence to J. Leick.

Additional information

M. Möckel für die Task Force Patientenpfade.

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Leick, J., Hamm, C., Böning, A. et al. „Standard operating procedures“ zur Diagnostik und Therapie des akuten Aortensyndroms. Kardiologe 7, 326–345 (2013). https://doi.org/10.1007/s12181-013-0511-6

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  • DOI: https://doi.org/10.1007/s12181-013-0511-6

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