Klug entscheiden – Bauchaortenaneurysma

Choosing wisely—Abdominal aortic aneurysms


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.


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.

This is a preview of subscription content, access via your institution.


  1. 1.

    Bicknell CD, Kiru G, Falaschetti E, Powell JT, Poulter NR (2016) An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysm: a randomised placebo-controlled trial (AARDVARK). Eur Heart J 37:3213–3221

    CAS  Article  Google Scholar 

  2. 2.

    Baddour LM, Bettmann MA, Bolger AF, Epstein AE, Ferrieri P, Gerber MA et al (2003) Nonvalvular cardiovascular device-related infections. Circulation 108:2015–2031

    Article  Google Scholar 

  3. 3.

    Brady AR, Gibbs JSR, Greenhalgh RM, Powell JT, Sydes MR (2005) Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg 41:602–609

    CAS  Article  Google Scholar 

  4. 4.

    Cornuz J, Sidoti Pinto C, Tevaearai H, Egger M (2004) Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies. Eur J Public Health 14:343–349

    Article  Google Scholar 

  5. 5.

    Cosford PA, Leng GC (2007) Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev 2:CD2945

    Google Scholar 

  6. 6.

    Debus ES, Heidemann F, Gross-Fengels W et al (2018) S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas (AWMF-Registernummer 004-14)

    Google Scholar 

  7. 7.

    Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847

    CAS  Article  Google Scholar 

  8. 8.

    EVAR trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 365:2187–2192

    Article  Google Scholar 

  9. 9.

    Filardo G, Powell JT, Martinez MA, Ballard DJ (2015) Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev 2:CD1835. https://doi.org/10.1002/14651858.cd001835.pub4

    Article  Google Scholar 

  10. 10.

    Grundmann RT, Thomsen J (2020) Bauchaortenaneurysma. In: Debus ES, Grundmann RT (Hrsg) Versorgungsqualität in der operativen Medizin. Springer, Berlin, Heidelberg

    Google Scholar 

  11. 11.

    Hartmann-Boyce J, Aveyard P (2016) Drugs for smoking cessation. BMJ 352:i571

    Article  Google Scholar 

  12. 12.

    Hicks CW, Zarkowsky DS, Bostock IC, Stone DH, Black JH 3rd, Eldrup-Jorgensen J, Goodney PP, Malas MB (2017) Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes. J Vasc Surg 65:1625–1635

    Article  Google Scholar 

  13. 13.

    Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2015) IQWiG-Berichte- Nr. 294. Ultraschall-Screening auf Bauchaortenaneurysmen (Abschlussbericht S13–04)

    Google Scholar 

  14. 14.

    Jahangir E, Lipworth L, Edwards TL et al (2015) Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the southern community cohort study. J Epidemiol Community Health 69:481–488

    Article  Google Scholar 

  15. 15.

    Karanikola E, Dalainas I, Karaolanis G, Zografos G, Filis K (2014) Duplex ultrasound versus computed tomography for the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Where do we stand now? Int J Angiol 23:155–164

    Article  Google Scholar 

  16. 16.

    Kokje VBC, Hamming JF, Lindeman JHN (2015) Editor’s choice—pharmaceutical management of small abdominal aortic aneurysms: a systematic review of the clinical evidence. Eur J Vasc Endovasc Surg 50:702–713

    CAS  Article  Google Scholar 

  17. 17.

    Kontopodis N, Galanakis N, Antoniou SA et al (2020) Meta-analysis and meta-regression analysis of outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 59:399–410

    Article  Google Scholar 

  18. 18.

    Meijer CA, Stijnen T, Wasser MN, Hamming JF, van Bockel JH, Lindeman JH, Pharmaceutical Aneurysm Stabilisation Trial Study Group (2013) Doxycycline for stabilisation of aortic aneurysm: a randomised trial. Ann Intern Med 159:815–823

    Article  Google Scholar 

  19. 19.

    Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A et al (2018) Editor’s choice—management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg 55:3–81

    CAS  Article  Google Scholar 

  20. 20.

    Nishimura RA, Carabello BA, Faxon DP, Freed MD, Lytle BW, O’Gara PT et al (2008) ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American college of cardiology/American heart association task force on practice guidelines: endorsed by the society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, and society of thoracic surgeons. Circulation 118:887–896

    Article  Google Scholar 

  21. 21.

    RESCAN Collaborators, Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG (2013) Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA 309:806–813

    Article  Google Scholar 

  22. 22.

    Rughani G, Robertson L, Clarke M (2012) Medical treatment for small abdominal aortic aneurysms. Cochrane Database Syst Rev 9:CD9536

    Google Scholar 

  23. 23.

    Scott SW, Batchelder AJ, Kirkbride D, Naylor AR, Thompson JP (2016) Late survival in nonoperated patients with infrarenal abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 52:444–449

    CAS  Article  Google Scholar 

  24. 24.

    Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD (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  Google Scholar 

  25. 25.

    Sweeting MJ, Thompson SG, Brown LC, Powell JT, RESCAN collaborators (2012) Meta-analysis of individual patient data to examine factors affecting the growth and rupture of abdominal aortic aneurysms. Br J Surg 99:655–665

    CAS  Article  Google Scholar 

  26. 26.

    Sweeting MJ, Patel R, Powell JT, Greenhalgh RM, EVAR Trial Investigators (2017) Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: very long-term follow-up in the EVAR‑2 randomized controlled trial. Ann Surg 266:713–719

    Article  Google Scholar 

  27. 27.

    Thompson SG, Brown LC, Sweeting MJ, Bown MJ, Kim LG, Glover MJ, Buxton MJ, Powell JT (2013) Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess 17:1–118

    CAS  Article  Google Scholar 

  28. 28.

    Trenner M, Kuehnl A, Salvermoser M et al (2018) Editor’s choice—high annual hospital volume is associated with decreased in hospital mortality and complication rates following treatment of abdominal aortic aneurysms: secondary data analysis of the nationwide German DRG statistics from 2005 to 2013. Eur J Vasc Endovasc Surg 55:185–194

    Article  Google Scholar 

  29. 29.

    Trenner M, Salvermoser M, Busch A, Schmid V, Eckstein H‑H, Kühnl A (2020) Mindestmengeneffekte bei der Therapie des abdominalen Aortenaneurysmas. Sekundärdatenanalyse der deutschen DRG-Statistik. Dtsch Arztebl. https://doi.org/10.3238/arztebl.2020.0820

    Article  Google Scholar 

  30. 30.

    Varkevisser RRB, Swerdlow NJ, de Guerre LEVM, Society for Vascular Surgery Vascular Quality Initiative et al (2020) Five-year survival following endovascular repair of ruptured abdominal aortic aneurysms is improving. J Vasc Surg 72:105–113.e4

    Article  Google Scholar 

  31. 31.

    Wanhainen A, Verzini F, Van Herzeele I et al (2019) Editor’s choice—European society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 57:8–93

    Article  Google Scholar 

  32. 32.

    Yang H, Raymer K, Butler R, Parlow J, Roberts R (2006) The effects of perioperative beta-blockade: results of the metoprolol after vascular surgery (maVS) study, a randomized controlled trial. Am Heart J 152:983–990

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

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

Ethics declarations


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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation


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


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