Download PDF
Der Klinikarzt 2017; 46(06): 286-294
DOI: 10.1055/s-0043-112317
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Das abdominale Aortenaneurysma

Ultraschall-Screening, Diagnostik, Therapie
Matthias Trenner
1   Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar und Münchener Aorten Centrum (MAC) der Technischen Universität München, München
,
Benedikt Reutersberg
1   Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar und Münchener Aorten Centrum (MAC) der Technischen Universität München, München
,
Albert Busch
1   Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar und Münchener Aorten Centrum (MAC) der Technischen Universität München, München
,
Kerstin Stoklasa
1   Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar und Münchener Aorten Centrum (MAC) der Technischen Universität München, München
,
Hans-Henning Eckstein
1   Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar und Münchener Aorten Centrum (MAC) der Technischen Universität München, München
› Author Affiliations
Further Information

Publication History

Publication Date:
17 July 2017 (online)

Also available at
    Permissions and Reprints

ZUSAMMENFASSUNG

Das abdominale Aortenaneurysma (AAA) ist das häufigste Aneurysma der großen Arterien. Die offen-chirurgische oder endovaskuläre Therapie ist die einzige Option, eine unmittelbar lebensbedrohliche Aneurysmaruptur zu verhindern. Der folgende Artikel gibt eine Übersicht über den aktuellen Wissensstand zu Epidemiologie, Pathogenese, Diagnostik und Ultraschall-Screening sowie Therapie des AAA. Zusätzlich werden Behandlungsdaten von 965 AAA-Patienten aus der eigenen Klinik vorgestellt.

 
  • 1 Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007: Cd002945
    PubMedGoogle Scholar
  • 2 Lindholt JS, Norman P. Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid- and long-term effects of screening for abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2008; 36: 167-171
    CrossrefPubMedGoogle Scholar
  • 3 Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Lancet 1998; 352: 1649-1655
    CrossrefPubMedGoogle Scholar
  • 4 Lederle FA, Johnson GR, Wilson SE. et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1425-1430
    CrossrefPubMedGoogle Scholar
  • 5 Lederle FA, Johnson GR, Wilson SE. et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med 1997; 126: 441-449
    CrossrefPubMedGoogle Scholar
  • 6 Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 2011; 8: 92-102
    CrossrefPubMedGoogle Scholar
  • 7 Curci JA, Thompson RW. Adaptive cellular immunity in aortic aneurysms: cause, consequence, or context?. J Clin Invest 2004; 114: 168-171
    CrossrefPubMedGoogle Scholar
  • 8 Lindsay ME, Dietz HC. Lessons on the pathogenesis of aneurysm from heritable conditions. Nature 2011; 473: 308-316
    CrossrefPubMedGoogle Scholar
  • 9 Moll FL, Powell JT, Fraedrich G. et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 (Suppl. 01) S1-s58
    CrossrefPubMedGoogle Scholar
  • 10 LaRoy LL, Cormier PJ, Matalon TA. et al. Imaging of abdominal aortic aneurysms. AJR Am J Roentgenol 1989; 152: 785-792
    CrossrefPubMedGoogle Scholar
  • 11 DGG. Bauchaortenaneurysma und Beckenarterienaneurysma (S2). In: Leitlinien zu Diagnostik und Therapie in der Gefäßchirurgie. Berlin, Heidelberg: Springer Berlin Heidelberge; 2010: 73-80
    CrossrefGoogle Scholar
  • 12 Eckstein HH, Bockler D, Flessenkamper I. et al. Ultrasonographic screening for the detection of abdominal aortic aneurysms. Dtsch Arztebl Int 2009; 106: 657-663
    PubMedGoogle Scholar
  • 13 Cropley M, Theadom A, Pravettoni G, Webb G. The effectiveness of smoking cessation interventions prior to surgery: a systematic review. Nicotine Tob Res 2008; 10: 407-412
    CrossrefPubMedGoogle Scholar
  • 14 Bath MF, Saratzis A, Saedon M. et al. Patients with Small Abdominal Aortic Aneurysm are at Significant Risk of Cardiovascular Events and this Risk is not Addressed Sufficiently. Eur J Vasc Endovasc Surg 2017; 53: 255-260
    CrossrefPubMedGoogle Scholar
  • 15 Karthikesalingam A, Vidal-Diez A, Holt PJ. et al. Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States. N Engl J Med 2016; 375: 2051-2059
    CrossrefPubMedGoogle Scholar
  • 16 Grundmann RT. Versorgung des abdominellen Aortenaneurysmas (AAA) 2014. Gefässchirurgie 2015; 20: 376-384
    CrossrefPubMedGoogle Scholar
  • 17 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
    CrossrefPubMedGoogle Scholar
  • 18 Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years‘ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet 2016; 388: 2366-2374
    CrossrefPubMedGoogle Scholar
  • 19 Barnes R, Kassianides X, Barakat H. et al. Ruptured AAA: Suitability for Endovascular Repair is Associated with Lower Mortality Following Open Repair. World Journal of Surgery 2014; 38: 1223-1226
    CrossrefPubMedGoogle Scholar
  • 20 Slater BJ, Harris EJ, Lee JT. Anatomic suitability of ruptured abdominal aortic aneurysms for endovascular repair. Ann Vasc Surg 2008; 22: 716-722
    CrossrefPubMedGoogle Scholar
  • 21 Holt PJ, Karthikesalingam A, Poloniecki JD. et al. Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm. Br J Surg 2010; 97: 496-503
    CrossrefPubMedGoogle Scholar
  • 22 McPhee J, Eslami MH, Arous EJ. et al. Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001-2006). : a significant survival benefit over open repair is independently associated with increased institutional volume. J Vasc Surg 2009; 49: 817-826
    CrossrefPubMedGoogle Scholar
  • 23 van Beek SC, Conijn AP, Koelemay MJ, Balm R. Editor’s Choice - Endovascular aneurysm repair versus open repair for patients with a ruptured abdominal aortic aneurysm: a systematic review and meta-analysis of short-term survival. Eur J Vasc Endovasc Surg 2014; 47: 593-602
    CrossrefPubMedGoogle Scholar
  • 24 van Beek SC, Vahl A, Wisselink W. et al. Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2015; 49: 661-668
    CrossrefPubMedGoogle Scholar
  • 25 Marlow NE, Barraclough B, Collier NA. et al. Effect of hospital and surgeon volume on patient outcomes following treatment of abdominal aortic aneurysms: a systematic review. Eur J Vasc Endovasc Surg 2010; 40: 572-579
    CrossrefPubMedGoogle Scholar
  • 26 Phillips P, Poku E, Essat M. et al. Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review. Eur J Vasc Endovasc Surg 2017; 53: 77-88
    CrossrefPubMedGoogle Scholar
  • 27 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). Part 3: Predictors of perioperative outcome with a focus on annual caseload (English Version). Gefässchirurgie 2015; 20: 32-44
    PubMedGoogle Scholar
  • 28 Härtl F, Reeps C, Wilhelm M, Ockert S, Zimmermann A, Eckstein HH. Offene und endovaskuläre Therapie des abdominalen Aortenaneurysmas: Krankheitsbild – Evidenz – Ergebnisse. Dtsch med Wochenschr 2012; 137: 1303-1308
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier HP, Eckstein HH. 12 Jahre „Qualitätssicherung BAA“ der DGG- Teil 1: Trends in Therapie und Outcome des nicht rupturierten abdominellen Aortenaneurysmas in Deutschland zwischen 1999 und 2010. Gefässchirurgie 2013; 18: 206-213
    CrossrefPubMedGoogle Scholar
  • 30 Eckstein HH, Härtl F. Abdominale und thorakale Aortenerkrankungen. klinikarzt 2011; 40: 410-417
    PubMedGoogle Scholar