Klug entscheiden – Bauchaortenaneurysma

Choosing wisely—Abdominal aortic aneurysms

Zusammenfassung

In der vorliegenden Arbeit sollen wichtige Positiv- und Negativ-Empfehlungen zur Versorgung des Bauchaortenaneurysmas (AAA) anhand der Leitlinien der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG) und der Leitlinien der European Society for Vascular and Endovascular Surgery (ESVS) aufgeführt werden. Positiv-Empfehlungen beziehen sich auf das Screening, die Überwachung kleiner Aneurysmen, das Aufgeben des Rauchens, die Indikationsstellung bei symptomfreiem AAA, die Therapiewahl bei intaktem und rupturiertem AAA sowie auf das Follow-up nach endovaskulärer AAA-Versorgung (EVAR). Nicht empfohlen werden eine medikamentöse Therapie des AAA, eine prophylaktische Karotisintervention bei symptomfreier Karotisstenose vor AAA-Versorgung sowie die Einleitung einer β‑Blocker-Therapie vor dem Eingriff. Die elektive AAA-Versorgung bei Patienten mit eingeschränkter Lebenserwartung und die Versorgung in Zentren mit weniger als 20 AAA-Versorgungen/Jahr wird ebenfalls abgelehnt. Eine Antibiotikaprophylaxe bei Patienten mit Zahnbehandlung bei vorausgegangener AAA-Versorgung wird als nicht indiziert angesehen. Die Ausführungen betonen einige Empfehlungen der Leitlinien, sollen aber deren Studium nicht ersetzen.

Abstract

Important positive and negative recommendations for the treatment of abdominal aortic aneurysms (AAA) are presented based on the guidelines of the German Society for Vascular Surgery and Vascular Medicine (DGG) and the guidelines of the European Society for Vascular and Endovascular Surgery (ESVS). Positive recommendations relate to AAA screening, monitoring of small aneurysms, quitting smoking, the indications for asymptomatic AAA repair, the choice of treatment for intact and ruptured AAA, and the follow-up after endovascular AAA repair (EVAR). Drug therapy for AAA, prophylactic carotid interventions in asymptomatic carotid stenosis prior to AAA treatment and initiation of treatment with beta blockers prior to the procedure are not recommended. Elective AAA repair in patients with limited life expectancy and treatment in centers with less than 20 AAA repairs/year are also rejected. Routine use of secondary antibiotic prophylaxis during dental procedures after preceding AAA repair is not recommended. The statements emphasize some of the recommendations of the guidelines but are not intended to replace their study.

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Correspondence to Prof. Dr. R. T. Grundmann.

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Interessenkonflikt

R.T. Grundmann und E.S. Debus geben 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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Grundmann, R.T., Debus, E.S. Klug entscheiden – Bauchaortenaneurysma. Gefässchirurgie (2021). https://doi.org/10.1007/s00772-021-00749-1

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Schlüsselwörter

  • Leitlinien
  • AAA-Screening
  • Behandlungsempfehlungen
  • Behandlungseinschränkungen
  • Behandlungsqualität

Keywords

  • Guidelines
  • AAA screening
  • Treatment recommendations
  • Treatment restrictions
  • Treatment quality