Endovaskuläre vs. konventionelle Gefäßchirurgie – antiquiertes Denken?

Teil 1: Eingriffe an der Aorta

Endovascular versus conventional vascular surgery – old-fashioned thinking?

Part 1: interventions on the aorta

Zusammenfassung

Die endovaskuläre Gefäßchirurgie hat die konventionelle operative Gefäßchirurgie in weiten Bereichen verdrängt. Dies hat dazu geführt, dass beide Techniken vielerorts als miteinander konkurrierende Verfahren angesehen werden. Evidenzbasierte Daten aus randomisierten Studien, Metaanalysen und klinischen Registern belegen jedoch zunehmend deutlich, dass sich die beiden Technologien komplementär ergänzen. Dabei ist es von der jeweiligen Grunderkrankung und der Anatomie abhängig, welcher der beiden Vorgehensweisen der Vorzug zu geben ist – wobei auch die kombinierte Nutzung beider Verfahren (Hybridtechnik) sinnvoll sein kann. Die vorliegende Übersicht konzentriert sich auf die Versorgung der akuten komplizierten Aortendissektion Typ B, auf Aneurysmen der deszendierenden thorakalen Aorta, auf thorakoabdominelle Aortenaneurysmen sowie das asymptomatische und rupturierte Bauchaortenaneurysma.

Abstract

Endovascular therapy has widely replaced conventional open vascular surgical reconstruction. For this reason both techniques were widely considered to be competing approaches. Evidence-based data from randomized prospective trials, meta-analyses and clinical registries, however, demonstrated that both techniques should be used to complement each other. It became increasingly more evident that the use of either procedure depends on the underlying disease and the anatomical conditions, whereby a combination of both (hybrid approach) may be the preferred option in certain situations. This review focuses on the treatment of complicated acute type B aortic dissection, descending thoracic aortic aneurysms, thoracoabdominal aortic aneurysms as well as asymptomatic and ruptured abdominal aortic aneurysms.

This is a preview of subscription content, log in to check access.

Literatur

  1. 1.

    Debus ES, Grundmann RT (2015) Evidenzbasierte Gefäßchirurgie. Springer, Berlin. (Kapitel 2)

    Google Scholar 

  2. 2.

    Moulakakis KG, Mylonas SN, Dalainas I et al (2014) Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg 3:234–246

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Ramdass M (2015) TEVAR for symptomatic Stanford B dissection: a systematic review of 30-day mortality and morbidity. Thorac Cardiovasc Surg 63:97–112

    PubMed  Google Scholar 

  4. 4.

    Mody PS, Wang Y, Geirsson A et al (2014) Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000–2011. Circ Cardiovasc Qual Outcomes 7:920–928

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Sachs T, Pomposelli F, Hagberg R et al (2010) Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample. J Vasc Surg 52:860–866

    Article  PubMed  Google Scholar 

  6. 6.

    Luebke T, Brunkwall J (2014) Cost-effectiveness of endovascular versus open repair of acute complicated type B aortic dissections. J Vasc Surg 59:1247–1255

    Article  PubMed  Google Scholar 

  7. 7.

    Hogendoorn W, Hunink MG, Schlösser FJ et al (2014) Endovascular vs. open repair of complicated acute type B aortic dissections. J Endovasc Ther 21:503–514

    Article  PubMed  Google Scholar 

  8. 8.

    Chou HP, Chang HT, Chen CK et al (2015) Outcome comparison between thoracic endovascular and open repair for type B aortic dissection: a population-based longitudinal study. J Chin Med Assoc 78:241–248

    Article  PubMed  Google Scholar 

  9. 9.

    Thrumurthy SG, Karthikesalingam A, Patterson BO et al (2011) A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg 42:632–647

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Tian DH, De Silva RP, Wang T, Yan TD (2014) Open surgical repair for chronic type B aortic dissection: a systematic review. Ann Cardiothorac Surg 3:340–350

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Fujikawa T, Yamamoto S, Sekine Y et al (2015) Operative results and clinical features of chronic Stanford type B aortic dissection: examination of 234 patients over 6 years. Eur J Vasc Endovasc Surg. doi:10.1016/j.ejvs.2015.07.012

  12. 12.

    Debus ES, Grundmann RT (2015) Evidenzbasierte Gefäßchirurgie. Springer, Berlin. (Kapitel 3)

    Google Scholar 

  13. 13.

    Cheng D, Martin J, Shennib H et al (2010) Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 55:986–1001

    Article  PubMed  Google Scholar 

  14. 14.

    Jonker FH, Trimarchi S, Verhagen HJ et al (2010) Meta-analysis of open versus endovascular repair for ruptured descending thoracic aortic aneurysm. J Vasc Surg 51:1026–1032

    Article  PubMed  Google Scholar 

  15. 15.

    Iafrancesco M, Ranasinghe AM, Claridge MW et al (2014) Current results of endovascular repair of thoraco-abdominal aneurysms. Eur J Cardiothorac Surg 46:981–984

    Article  PubMed  Google Scholar 

  16. 16.

    Guillou M, Bianchini A, Sobocinski J et al (2012) Endovascular treatment of thoracoabdominal aortic aneurysms. J Vasc Surg 56:65–73

    Article  PubMed  Google Scholar 

  17. 17.

    Reilly LM, Rapp JH, Grenon SM et al (2012) Efficacy and durability of endovascular thoracoabdominal aortic aneurysm repair using the caudally directed cuff technique. J Vasc Surg 56:53–63

    Article  PubMed  Google Scholar 

  18. 18.

    Clough RE, Modarai B, Bell RE et al (2012) Total endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg 43:262–267

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Verhoeven EL, Katsargyris A, Bekkema F et al (2015) Ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur J Vasc Endovasc Surg 49:524–531

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Canaud L, Karthikesalingam A, Jackson D et al (2013) Clinical outcomes of single versus staged hybrid repair for thoracoabdominal aortic aneurysm. J Vasc Surg 58:1192–1200

    Article  PubMed  Google Scholar 

  21. 21.

    Rosset E, Ben Ahmed S, Galvaing G, Association Universitaire de Recherche en Chirurgie et al (2014) Editor̕s choice – hybrid treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms: a multicenter retrospective study. Eur J Vasc Endovasc Surg 47:470–478

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Hughes GC, Andersen ND, Hanna JM, McCann RL (2012) Thoracoabdominal aortic aneurysm: hybrid repair outcomes. Ann Cardiothorac Surg 1:311–319

    PubMed  PubMed Central  Google Scholar 

  23. 23.

    Coselli JS, Lemaire SA, Weldon SA (2012) Extent II repair of thoracoabdominal aortic aneurysm secondary to chronic dissection. Ann Cardiothorac Surg 1:394–397

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Bensley RP, Curran T, Hurks R et al (2013) Open repair of intact thoracoabdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg 58:894–900

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Lemaire SA, Price MD, Green SY et al (2012) Results of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg 1:286–292

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Brown LC, Powell JT, Thompson SG et al (2012) The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health Technol Assess 16(9):1–218

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    de Bruin JL, Baas AF, Buth J, DREAM Study Group et al (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362: 1881–1889

    Article  PubMed  Google Scholar 

  28. 28.

    de Bruin JL, Vervloet MG, Buimer MG, DREAM Study Group et al (2013) Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. Br J Surg 100:1465–1470

    Article  PubMed  Google Scholar 

  29. 29.

    Nguyen BN, Neville RF, Rahbar R et al (2013) Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency. Ann Surg 258:394–399

    Article  PubMed  Google Scholar 

  30. 30.

    Lovegrove RE, Javid M, Magee TR, Galland RB (2008) A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 95:677–684

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Stather PW, Sidloff D, Dattani N et al (2013) Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg 100:863–872

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Paravastu SC, Jayarajasingam R, Cottam R et al (2014) Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev 1:CD004178

    PubMed  Google Scholar 

  33. 33.

    Schermerhorn ML, Buck DB, O̕’Malley AJ et al (2015) Long-term outcomes of abdominal aortic aneurysm in the Medicare population. N Engl J Med 373:328–338

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Badger S, Bedenis R, Blair PH et al (2014) Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev 7:CD005261

    PubMed  Google Scholar 

  35. 35.

    Reimerink JJ, Hoornweg LL, Vahl AC, Amsterdam Acute Aneurysm Trial Collaborators et al (2013) Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg 258:248–256

    Article  PubMed  Google Scholar 

  36. 36.

    IMPROVE Trial Investigators, Powell JT, Sweeting MJ, Thompson MM et al (2014) Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 348:f7661

    Article  Google Scholar 

  37. 37.

    Gunnarsson K, Wanhainen A, Djavani Gidlund K et al (2015) Endovascular versus open repair as primary strategy for ruptured abdominal aortic aneurysm: a national population-based study. Eur J Vasc Endovasc Surg. doi:10.1016/j.ejvs.2015.07.001

  38. 38.

    Gupta PK, Ramanan B, Engelbert TL et al (2014) A comparison of open surgery versus endovascular repair of unstable ruptured abdominal aortic aneurysms. J Vasc Surg 60:1439–1445

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Prof. Dr. E. S. Debus.

Ethics declarations

Interessenkonflikt

E.S. Debus, T. Kölbel, D. Manzoni, C.-A. Behrendt, F. Heidemann und R.T. Grundmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Den Beitrag „Endovaskuläre vs. konventionelle Gefäßchirurgie – antiquiertes Denken? Teil 2: Karotisstenose und periphere arterielle Verschlusskrankheit“ finden Sie in Ausgabe 4/2016 von Der Chirurg oder unter DOI:10.1007/s00104-015-0149-y

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Debus, E.S., Kölbel, T., Manzoni, D. et al. Endovaskuläre vs. konventionelle Gefäßchirurgie – antiquiertes Denken?. Chirurg 87, 195–201 (2016). https://doi.org/10.1007/s00104-015-0146-1

Download citation

Schlüsselwörter

  • Endovaskulär
  • Offene Chirurgie
  • Aortendissektion
  • Thorakales Aortenaneurysma
  • Abdominelles Aortenaneurysma

Keywords

  • Endovascular repair
  • Open repair
  • Aortic dissection
  • Thoracic aortic aneurysm
  • Abdominal aortic aneurysm