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Trenner M, Salvermoser M, Reutersberg B, Busch A, Schmid V, Eckstein HH, Kuehnl A. Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany. VASA 2020; 49:107-114. [DOI: 10.1024/0301-1526/a000830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Summary: Background: Abdominal aortic aneurysms (AAA) can be treated by either open surgery (OAR) or endovascular aortic repair (EVAR). The aim of this study was to analyze regional variations in application of (EVAR) and in-hospital mortality after intact AAA (iAAA) repair. Methods: Using data provided by the German Federal Statistical Office, a nationwide analysis for 2012 to 2014 was conducted. Patients with a diagnosis of iAAA (I71.4) and corresponding procedure codes for OAR (5-384.5/7) or EVAR (5-38a.1) were included. Odds ratios (ORs) for use of EVAR (proportion of EVAR among total EVAR + OAR cases) and mortality were calculated for all regions in Germany. ORs for EVAR use were adjusted for age, sex, and risk (Elixhauser score). ORs for mortality were additionally adjusted for type of procedure (OAR/EVAR). Results: Finally, 31,757 procedures for iAAA were included. Median age of all patients was 73 years (interquartile range 67–78 years) and 87.1 % were male. The mean proportion of EVAR procedures was 72.6 %; however, the application of EVAR for repair of iAAA varied widely depending on region. The lowest unadjusted regional rate of EVAR use was 48.8 %, while the highest was 92.5 %. After adjustment, the lowest regional OR for EVAR use (compared to the nationwide mean) was 0.23 (95 % confidence interval [0.15–0.36]), the highest 5.93 [1.79–19.65]. Overall in-hospital mortality was 2.9 % (OAR 6.2 %; EVAR 1.7 %). The adjusted regional OR for mortality ranged from 0.31 [0.07–1.42] to 4.98 [2.08–11.93]. Conclusions: This study reveals variations in use of EVAR and in-hospital mortality for iAAA treatment in Germany. This may imply that selection of treatment might not only be influenced by patient characteristics, but also by regional location. These results need to be taken into account when discussing centralization of AAA treatment in Germany.
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Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Schmid
- Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Munich Aortic Centre (MAC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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de Mik SML, Indrakusuma R, Legemate DA, Balm R, Ubbink DT. Reporting of Complications and Mortality in Relation to Risk Communication in Patients with an Abdominal Aortic Aneurysm: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:796-807. [PMID: 31128986 DOI: 10.1016/j.ejvs.2019.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES High-quality reporting of surgical risks is necessary for evidence-based risk communication in clinical practice. Risk communication is defined as the process of discussing benefits and harms of treatment options with patients. This review addressed the current quality of reporting of complications and mortality in publications on abdominal aortic aneurysm treatment, with a focus on items relevant to risk communication. DESIGN A systematic review. MATERIALS Randomised clinical trials, comparative observational studies and registries from 2010 onwards were eligible if they reported complications and/or mortality in patients with an asymptomatic abdominal aortic aneurysms who received primary treatment. METHODS Quality of reporting was assessed by scoring items relevant to risk communication from the reporting standards of the Society for Vascular Surgery (SVS) and the Consolidated Standards of Reporting Trials (CONSORT) statement. Screening, quality assessment and data extraction were independently undertaken by two authors. RESULTS Forty-seven publications were included. Nine of 47 publications (19%) provided no definition of complications. In 14 of 47 publications (30%), it was unclear whether the number of adverse events or the number of patients with adverse events were presented. Absolute risk differences were provided in 1 of 32 publications (3.1%) that compared complications between two treatment options. Forty-six of 47 publications reported mortality, of which 42 reported overall mortality rates (91%). Absolute risk differences were given in 2 of the 31 publications (6.5%) that compared mortality between two treatment options. CONCLUSIONS The quality of reporting of complications and mortality following primary abdominal aortic aneurysm treatment varied considerably. Better adherence to the SVS reporting standards and the CONSORT statement, as well as stating absolute risk differences may improve the quality of reporting and facilitate evidence-based risk communication.
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Affiliation(s)
- Sylvana M L de Mik
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Reza Indrakusuma
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Dink A Legemate
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ron Balm
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Kühnl A, Erk A, Trenner M, Salvermoser M, Schmid V, Eckstein HH. Incidence, Treatment and Mortality in Patients with Abdominal Aortic Aneurysms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:391-398. [PMID: 28655374 DOI: 10.3238/arztebl.2017.0391] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 12/16/2016] [Accepted: 03/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aim of this study was to analyze hospital incidence, type of treatment, and hospital mortality rates of patients with abdominal aortic aneurysm (AAA) in Germany from 2005 to 2014. METHODS Microdata of the diagnosis-related group (DRG) statistics compiled by the German Federal Statistical Office for the years 2005-2014 were analyzed. Patients who were hospitalized for a ruptured AAA (rAAA, ICD-10 code I71.3, treated either surgically or conservatively) or received surgical treatment for an unruptured AAA (nrAAA, ICD-10-Code I71.4, treated either with open surgery or an endovascular procedure) were included in the analysis. The "European Standard Population 2013" was used for direct standardization of the hospital incidences. In-hospital mortality was calculated with standardization for age and risk. RESULTS The standardized overall hospital incidence of AAA was 27.9 and 3.3 cases per 100 000 people for men and women, respectively; over the period of the study, the incidence of rAAA fell by 30% in both sexes and that of nrAAA rose by 16% in men and 42% in women. The percentage of patients receiving endovascular treatment rose from 29% to 75% in patients with nrAAA and from 8% to 36% in patients with rAAA. The age- and risk-standardized in-hospital mortality of nrAAA was 3.3% in men and 5.3% in women. The in-hospital mortality of surgically treated rAAA was 39% in men and 48% in women. CONCLUSION The hospital incidence of AAA rose from 2005 to 2014, while that of rAAA fell. Endovascular treatment became more common for nrAAA as well as rAAA, and in-hospital mortality fell for both.
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Affiliation(s)
- Andreas Kühnl
- Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar, Technical University of Munich; Department of Statistics, Ludwig-Maximilians-University Munich
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Behrendt CA, Rieß HC, Diener H, Tsilimparis N, Heidemann F, Wipper S, Larena-Avellaneda AA, Kölbel T, Debus ES. [Abdominal aortic aneurysm]. MMW Fortschr Med 2018; 160:50-59. [PMID: 29855945 DOI: 10.1007/s15006-018-0018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Christian-Alexander Behrendt
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Deutschland.
| | - Henrik C Rieß
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Holger Diener
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Nikolaos Tsilimparis
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Franziska Heidemann
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sabine Wipper
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Axel-Antonio Larena-Avellaneda
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Tilo Kölbel
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - E Sebastian Debus
- Universitäres Herzzentrum Hamburg, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Initial Clinical Experience Using the Low-Profile Altura Endograft System With Double D-Shaped Proximal Stents for Endovascular Aneurysm Repair. J Endovasc Ther 2018; 25:379-386. [DOI: 10.1177/1526602818771973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the initial clinical results of endovascular aneurysm repair (EVAR) using the low-profile (14-F) Altura Endograft System, which features a double “D-shaped” stent design with suprarenal fixation and modular iliac components that are deployed from distal to proximal. Methods: From 2011 to 2015, 90 patients (mean age 72.8±8.3 years; 79 men) with abdominal aortic aneurysm (AAA; mean diameter 53.8±5.7 mm) were treated at 10 clinical sites in 2 prospective, controlled clinical studies using the Altura endograft. Outcomes evaluated included mortality, major adverse events (MAEs: all-cause death, stroke, paraplegia, myocardial infarction, respiratory failure, bowel ischemia, and blood loss ≥1000 mL), and clinical success (freedom from procedure-related death, type I/III endoleak, migration, thrombosis, and reintervention). Results: Endografts were successfully implanted in 89 (99%) patients; the single failure was due to delivery system malfunction before insertion in the early-generation device. One (1%) patient died and 4 patients underwent reinterventions (1 type I endoleak, 2 iliac limb stenoses, and 1 endograft occlusion) within the first 30 days. During a median follow-up of 12.5 months (range 11.5–50.9), there were no aneurysm ruptures, surgical conversions, or AAA-related deaths. The cumulative MAE rates were 3% (3/89) at 6 months and 7% (6/89) at 1 year. Two patients underwent coil embolization of type II endoleaks at 6.5 months and 2.2 years, respectively. Clinical success was 94% (84/89) at 30 days, 98% (85/87) at 6 months, and 99% (82/83) at 1 year. Conclusion: Early results suggest that properly selected AAA patients can be safely treated using the Altura Endograft System with favorable midterm outcome. Thus, further clinical investigation is warranted to evaluate the role of this device in the treatment of AAA.
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Trenner M, Kuehnl A, Reutersberg B, Salvermoser M, Eckstein HH. Nationwide analysis of risk factors for in-hospital mortality in patients undergoing abdominal aortic aneurysm repair. Br J Surg 2018; 105:379-387. [PMID: 29417985 DOI: 10.1002/bjs.10714] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/03/2017] [Accepted: 09/02/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is increasing awareness that women may have worse outcomes following repair of abdominal aortic aneurysm (AAA). The aim of this study was to analyse the association between sex, age and in-hospital mortality after AAA using hospital episode data collected routinely at the nationwide level. METHODS Data were extracted from the nationwide statutory Diagnosis Related Group statistics provided by the German Federal Statistical Office. Patients with a diagnosis of intact (non-ruptured) AAA (ICD-10 GM I71.4) and procedure codes (OPS; 2005-2013) for endovascular aneurysm repair (EVAR) (5-38a.1*) or open aneurysm repair (5-384.5, 5-384.7), treated from 2005 to 2013, were included. A multilevel multivariable regression model was applied to adjust for medical risk (using the Elixhauser co-morbidity score), type of procedure, type of admission, and to account for clustering of patients within centres. The primary outcome was in-hospital mortality. RESULTS Some 84 631 patients were identified, of whom 10 039 (11·9 per cent) were women. Women were significantly older than men at admission (median 74 (i.q.r. 69-80) versus 72 (66-77) years; P < 0·001). EVAR was used less frequently in women (48·1 versus 54·7 per cent; P < 0·001). The in-hospital mortality rate was higher in women, overall (5·0 versus 3·1 per cent; relative risk 1·60, 95 per cent c.i. 1·45 to 1·75), and for EVAR (2·8 versus 1·5 per cent; RR 1·90, 1·60 to 2·30) and open repair (6·8 versus 5·0 per cent; RR 1·36, 1·22 to 1·52). In-hospital mortality increased with age and was highest in patients aged over 80 years. In multivariable regression analysis, female sex (RR 1·20, 1·07 to 1·35) and age per 10-year increase (RR 1·83, 1·73 to 1·95) were independent risk factors for higher in-hospital mortality. CONCLUSION In Germany, women were older when undergoing AAA repair and were less likely to receive EVAR. Mortality rates were higher in older patients and in women, irrespective of the surgical technique used.
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Affiliation(s)
- M Trenner
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar and Munich Aortic Centre, Technical University Munich, Munich, Germany
| | - A Kuehnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar and Munich Aortic Centre, Technical University Munich, Munich, Germany
| | - B Reutersberg
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar and Munich Aortic Centre, Technical University Munich, Munich, Germany
| | - M Salvermoser
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar and Munich Aortic Centre, Technical University Munich, Munich, Germany
| | - H-H Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar and Munich Aortic Centre, Technical University Munich, Munich, Germany
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Trenner M, Haller B, Storck M, Reutersberg B, Kallmayer MA, Eckstein HH. Trends in Patient Safety of Intact Abdominal Aortic Aneurysm Repair: German Registry Data on 36,594 Procedures. Eur J Vasc Endovasc Surg 2017; 53:641-647. [PMID: 28110907 DOI: 10.1016/j.ejvs.2016.12.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE/BACKGROUND The study aim was to determine whether patient safety for non-ruptured abdominal aortic aneurysm (nrAAA) repair has changed between 1999 and 2010 in a large German cohort. METHODS The data source was the prospective quality assurance registry of the German Vascular Society from 1999 to 2010. Patient characteristics, surgical techniques (open aortic repair [OAR], endovascular aortic repair [EVAR]), procedural time and outcomes, including the length of hospital stay (LOS), were analysed using the Cochran-Armitage test for binary parameters and Spearman's correlation coefficient for quantitative parameters. RESULTS A total of 36,594 operations (23,037 OAR, 13,557 EVAR) for infrarenal nrAAA in 201 hospitals in Germany were investigated. Patients' mean age increased from 69.6 to 72.0 years (p < .001). The rate of patients with American Society of Anesthesiologists scores of 3 or 4 increased (p < .001). Use of EVAR increased (1999: 16.7%; 2010: 62.7%; p < .001), and since 2009, EVAR has been more frequently used than OAR. The overall in hospital mortality decreased from 3.1% in 1999 to 2.3% in 2010 (p < .001). There were no temporal trends for mortality rates for EVAR (p = .233) or OAR (p = .281) when considered separately. Cardiac (1999: 8.1%; 2010: 5.1%; p < .001) and pulmonary (1999: 7.8%; 2010: 4.8%; p < .001) complications decreased. The rate of post-operative renal failure increased (1999: 3.6%; 2010 4.1%; p = .017), without increasing the rate of patients needing dialysis (1999: 1.7%; 2010: 1.7%; p = .171). The median LOS decreased from 17 days in 1999 to 10 days in 2010 (p < .001). CONCLUSION This study shows significantly improved post-procedural in hospital outcomes and decreased use of resources for nrAAA repair. This trend can probably be attributed to the implementation of EVAR as a standard technique, but some trends could also possibly be explained by a change in the remuneration system. The main limitation of the registry is the lack of internal and external validation. However, in hospital patient safety for AAA repair seems to have improved significantly in the participating hospitals.
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Affiliation(s)
- M Trenner
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - M Storck
- Department for Vascular and Thoracic Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Commission for Quality and Safety, German Vascular Society (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG), Berlin, Germany
| | - B Reutersberg
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M A Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - H-H Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Behrendt CA, Heidemann F, Rieß HC, Kölbel T, Debus ES. Therapie des Bauchaortenaneurysmas. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-015-0042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Perioperative Letalität bei der Versorgung abdomineller Aortenaneurysmen in Deutschland. Chirurg 2015; 86:1041-50. [DOI: 10.1007/s00104-015-0087-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tanios F, Gee M, Pelisek J, Kehl S, Biehler J, Grabher-Meier V, Wall W, Eckstein HH, Reeps C. Interaction of Biomechanics with Extracellular Matrix Components in Abdominal Aortic Aneurysm Wall. Eur J Vasc Endovasc Surg 2015; 50:167-74. [DOI: 10.1016/j.ejvs.2015.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
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Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier H, Eckstein HH. Twelve years of the quality assurance registry on ruptured and non-ruptured abdominal aortic aneurysms of the German Vascular Society (DGG). GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00772-014-1401-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rückert RI, Hanack U, Aronés-Gomez S, Yousefi S. [Aneurysms of the abdominal aorta and iliac arteries: paradigm shift - operative therapy, if possible endovascular?]. Chirurg 2014; 85:782-90. [PMID: 25200628 DOI: 10.1007/s00104-014-2718-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations. OBJECTIVES New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs. MATERIAL AND METHODS A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence. RESULTS Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary. CONCLUSION Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance.
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Affiliation(s)
- R I Rückert
- Klinik für Gefäß- und endovaskuläre Chirurgie, Allgemein- und Viszeralchirurgie Franziskus-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland,
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Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier H, Eckstein HH. 12 Jahre „Qualitätssicherung BAA“ der DGG. GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1194-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bischoff M, Hafner S, Able T, Peters A, Hyhlik-Dürr A, Böckler D. Inzidenz und Therapie des Postimplantationssyndroms nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen. GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1193-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kardiovaskuläres Risiko bei EVAR und offener Operation des nicht rupturierten abdominalen Aortenaneurysmas. GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1185-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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