Zusammenfassung
Hintergrund
Das Bauchaortenaneurysma ist ein potenziell letales Krankheitsbild, das sowohl offen-chirurgisch als auch endovaskulär mittels Implantation einer Endoprothese behandelt werden kann.
Ziel
Trotz zahlreicher Studien ist die Frage, welche Therapieform zu bevorzugen ist, unübersichtlich. Daher soll eine Übersicht der relevanten Literatur vorgestellt und diskutiert werden.
Material und Methoden
Dieser Beitrag fasst die wichtigsten Publikationen zu den Themen der elektiven und notfallmäßigen Behandlung von Bauchaortenaneurysmen in einer kurzen Übersicht zusammen. Die publizierten Ergebnisse werden einander gegenübergestellt und interpretiert.
Ergebnisse
Die meisten randomisiert-kontrollierten Studien kommen zu dem Schluss, dass die endovaskuläre Aneurysmareparatur (EVAR) mit einer geringeren perioperativen Mortalität verbunden ist. Dieser kurzfristige Vorteil nivelliert sich allerdings nach wenigen Jahren wieder; in einigen Studien war die endovaskuläre Therapie sogar hinsichtlich der Mortalität nach 2–5 Jahren unterlegen. Neueste Daten zeigen allerdings keine signifikanten Überlebensunterschiede in der Langzeitbetrachtung. In allen Studien war die höhere Rate an sekundären Interventionen die Hauptlimitation der EVAR.
Diskussion
Da die Ergebnisse beider Verfahren langfristig vergleichbar sind, können beide auch weiterhin Anwendung finden. Die Wahl des Verfahrens hängt von klinischen, anatomischen und nicht zuletzt auch logistischen Kriterien ab.
Abstract
Background
Abdominal aortic aneurysms can either be treated by open surgery or endovascular repair. In both cases, prostheses are implanted to prevent potentially lethal aortic ruptures.
Objectives
Studies seeking to identify the optimal treatment came to diverging conclusions. The goal of this article is to shed light on the discussion of which treatment option is to be preferred.
Materials and methods
This article summarizes the relevant studies on elective and emergency abdominal aortic aneurysm repair. The presented studies are discussed, and results are interpreted and compared.
Results
While most studies indicate lower short-term mortality rates in endovascular aneurysm repair (EVAR), mortality rates converged in multiple trials and even showed a lower mortality rate for open repair in mid-term analyses. Most recent studies indicate long-term equivalence in terms of mortality and a higher rate of secondary interventions in EVAR patients.
Conclusions
The current body of literature indicates no real advantage of one therapy over another. The choice of therapy should depend on anatomic, clinical, and logistic criteria.
Literatur
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G.F. Torsello gibt an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Torsello, G.F. Endovaskuläre Aneurysmareparatur (EVAR). Radiologie 62, 580–585 (2022). https://doi.org/10.1007/s00117-022-01020-8
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DOI: https://doi.org/10.1007/s00117-022-01020-8
Schlüsselwörter
- Abdominelles Aortenaneurysma
- Rupturiertes Bauchaortenaneurysma
- Offener Aortenersatz
- Reinterventionen
- Überleben