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Endovaskuläre Therapie infrarenaler Aortenaneurysmen

Verändert die endovaskuläre Therapie die Indikationsstellung zugunsten kleinerer Durchmesser?

Endovascular repair of infrarenal aortic aneurysms

Does treatment change the indications in favor of smaller diameters?

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Zusammenfassung

Die Indikationsstellung zur elektiven endovaskulären Therapie des abdominellen Aortenaneurysmas (AAA) leitet sich von der konventionellen Aneurysmachirurgie ab und sieht eine Versorgung ab einem Aneurysmadurchmesser von 5 cm bzw. 5,5 cm vor. Dies geschieht in Abwägung des natürlichen Verlaufs (Rupturrisiko des AAA) und der operativen Mortalität und Morbidität des offenen Verfahrens. Der minimal-invasive Charakter der endovaskulären Versorgung, kombiniert mit einer signifikant niedrigeren perioperativen Mortalität, lässt jedoch im klinischen Alltag die Frage einer veränderten Indikationsstellung zugunsten einer Versorgung „kleiner Aneurysmen“ aufkommen. Ziel dieses Übersichtsartikels ist die Darstellung von Rationale und Ergebnissen einer frühelektiven endovaskulären Versorgung von „kleinen“ infrarenalen Aortenaneurysmen mit einem maximalen Durchmesser <5,0/5,5 cm anhand der aktuellen Studienlage (PIVOTAL, CAESAR).

Abstract

Endovascular treatment of patients with infrarenal aortic aneurysms is usually indicated for an aneurysm diameter >5 cm and is adapted from the indications for open repair. When deciding between aneurysm repair or surveillance the operative risk is balanced against the risk of rupture. The minimally invasive character of endovascular aneurysm repair (EVAR) combined with a reduced perioperative mortality compared to open repair raises the question whether patients with small aneurysms might benefit from an endovascular treatment instead of surveillance. This article reviews recent publications to illustrate the rationale and results of endovascular treatment of patients with infrarenal aortic aneurysms <5.0-5.5 cm compared to a surveillance strategy.

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Literatur

  1. Anonymous (1998) Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. UK Small Aneurysm Trial Participants. Lancet 352:1656–1660

    Article  Google Scholar 

  2. Anonymous (2002) Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346:1445–1452

    Article  Google Scholar 

  3. Anonymous (1998) 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 352:1649–1655

    Article  Google Scholar 

  4. Bayle O, Branchereau A, Rosset E et al (1997) Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning. J Vasc Surg 26:238–246

    Article  PubMed  CAS  Google Scholar 

  5. Bicknell CD, Cheshire NJ (2011) The CAESAR trial – highlighting the need for different end points. Eur J Vasc Endovasc Surg 41:26–27

    Article  PubMed  CAS  Google Scholar 

  6. Bockler D, Fitridge R, Wolf Y et al (2010) Rationale and design of the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE): interim analysis at 30 days of the first 180 patients enrolled. J Cardiovasc Surg (Torino) 51:481–491

    Google Scholar 

  7. Brown PM, Zelt DT, Sobolev B (2003) The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg 37:280–284

    Article  PubMed  Google Scholar 

  8. Cao P, De Rango P, Verzini F et al (2011) Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg 41:13–25

    Article  PubMed  CAS  Google Scholar 

  9. Darling RC, Messina CR, Brewster DC et al (1977) Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation 56:II161– II164

    PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  11. De Rango P, Cao P, Parlani G et al (2008) Outcome after endografting in small and large abdominal aortic aneurysms: a meta-analysis. Eur J Vasc Endovasc Surg 35:162–172

    Article  Google Scholar 

  12. De Rango P, Verzini F (2011) Rupture in small abdominal aortic aneurysms: beyond the rates. Eur J Vasc Endovasc Surg 41:11–12

    Article  Google Scholar 

  13. De Rango P, Verzini F, Parlani G et al (2011) Quality of life in patients with small abdominal aortic aneurysm: the effect of early endovascular repair versus surveillance in the CAESAR trial. Eur J Vasc Endovasc Surg 41:324–331

    Article  Google Scholar 

  14. Eckstein HH, Bockler D, Flessenkamper I et al (2009) Ultrasonographic screening for the detection of abdominal aortic aneurysms. Dtsch Arztebl Int 106:657–663

    PubMed  Google Scholar 

  15. Elzouki AN, Ryden Ahlgren A, Lanne T et al (1999) Is there a relationship between abdominal aortic aneurysms and α1-antitrypsin deficiency (PiZ)? Eur J Vasc Endovasc Surg 17:149–154

    Article  PubMed  CAS  Google Scholar 

  16. Gasser TC, Auer M, Labruto F et al (2010) Biomechanical rupture risk assessment of abdominal aortic aneurysms: model complexity versus predictability of finite element simulations. Eur J Vasc Endovasc Surg 40:176–185

    Article  PubMed  CAS  Google Scholar 

  17. Greenhalgh RM, Brown LC, Powell JT et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871

    Article  PubMed  Google Scholar 

  18. Hurks R, Hoefer IE, Vink A et al (2010) Different effects of commonly prescribed statins on abdominal aortic aneurysm wall biology. Eur J Vasc Endovasc Surg 39:569–576

    Article  PubMed  CAS  Google Scholar 

  19. Hyhlik-Durr A, Debus S, Eckstein HH et al (2010) Ultrasound screening in abdominal aortic aneurysm – numbers, data, facts. Zentralbl Chir 135:403–408

    Article  PubMed  CAS  Google Scholar 

  20. Kaijzel EL, Heijningen PM van, Wielopolski PA et al (2010) Multimodality imaging reveals a gradual increase in matrix metalloproteinase activity at aneurysmal lesions in live fibulin-4 mice. Circ Cardiovasc Imaging 3:567–577

    Article  PubMed  Google Scholar 

  21. Larsson E, Labruto F, Gasser TC et al (2011) Analysis of aortic wall stress and rupture risk in patients with abdominal aortic aneurysm with a gender perspective. J Vasc Surg

  22. Law MR, Morris J, Wald NJ (1994) Screening for abdominal aortic aneurysms. J Med Screen 1:110–115; discussion 115–116

    PubMed  CAS  Google Scholar 

  23. Lederle FA, Wilson SE, Johnson GR et al (2002) Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346:1437–1444

    Article  PubMed  Google Scholar 

  24. Li ZY, Sadat U, UK-I J et al (2010) Association between aneurysm shoulder stress and abdominal aortic aneurysm expansion: a longitudinal follow-up study. Circulation 122:1815–1822

    Article  PubMed  Google Scholar 

  25. Lindholt JS, Vammen S, Fasting H et al (2000) The plasma level of matrix metalloproteinase 9 may predict the natural history of small abdominal aortic aneurysms. A preliminary study. Eur J Vasc Endovasc Surg 20:281–285

    Article  PubMed  CAS  Google Scholar 

  26. Malkawi AH, Hinchliffe RJ, Holt PJ et al (2010) Percutaneous access for endovascular aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 39:676–682

    Article  PubMed  CAS  Google Scholar 

  27. Malkawi AH, Hinchliffe RJ, Xu Y et al (2010) Patient-specific biomechanical profiling in abdominal aortic aneurysm development and rupture. J Vasc Surg 52:480–488

    Article  PubMed  Google Scholar 

  28. Norman PE, Powell JT (2007) Abdominal aortic aneurysm: the prognosis in women is worse than in men. Circulation 115:2865–2869

    Article  PubMed  CAS  Google Scholar 

  29. Ouriel K, Clair DG, Kent KC et al (2010) Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg 51:1081–1087

    Article  PubMed  Google Scholar 

  30. Ouriel K, Srivastava SD, Sarac TP et al (2003) Disparate outcome after endovascular treatment of small versus large abdominal aortic aneurysm. J Vasc Surg 37:1206–1212

    Article  PubMed  Google Scholar 

  31. Peppelenbosch N, Buth J, Harris PL et al (2004) Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR. J Vasc Surg 39:288–297

    Article  PubMed  Google Scholar 

  32. Powell JT, Brown LC, Forbes JF et al (2007) Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial. Br J Surg 94:702–708

    Article  PubMed  CAS  Google Scholar 

  33. Powell JT, Gotensparre SM, Sweeting MJ et al (2011) Rupture rates of small abdominal aortic aneurysms: a systematic review of the literature. Eur J Vasc Endovasc Surg 41:2–10

    Article  PubMed  CAS  Google Scholar 

  34. Torsello G, Troisi N, Donas KP et al (2011) Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair. J Vasc Surg [Epub ahead of print]

  35. Verhoeven BA, Waasdorp EJ, Gorrepati ML et al (2011) Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair. J Vasc Surg 53:293–298

    Article  PubMed  Google Scholar 

  36. Wilson WR, Anderton M, Choke EC et al (2008) Elevated plasma MMP1 and MMP9 are associated with abdominal aortic aneurysm rupture. Eur J Vasc Endovasc Surg 35:580–584

    Article  PubMed  CAS  Google Scholar 

  37. Zarins CK, Crabtree T, Bloch DA et al (2006) Endovascular aneurysm repair at 5 years: Does aneurysm diameter predict outcome? J Vasc Surg 44:920–929; discussion 929–931

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    P. Geisbüsch & D. Böckler

  2. Baptist Cardiac and Vascular Institute, Division of Vascular and Interventional Radiology, Miami, Florida

    P. Geisbüsch & B.T. Katzen

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  1. P. Geisbüsch
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  2. B.T. Katzen
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  3. D. Böckler
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Correspondence to P. Geisbüsch.

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Geisbüsch, P., Katzen, B. & Böckler, D. Endovaskuläre Therapie infrarenaler Aortenaneurysmen. Gefässchirurgie 16, 584–589 (2011). https://doi.org/10.1007/s00772-011-0920-4

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