Zusammenfassung
Obwohl valide Daten zur bevölkerungsbezogenen Prävalenz und Inzidenz des abdominalen Aortenaneurysmas (AAA) in Deutschland noch fehlen, ist auf dem Boden von nationalen Screeningprogrammen in Schweden, USA und England von einer Häufigkeit des AAA in Höhe von 1,5 bis 3,6 % unter Männern über 65 Jahren auszugehen. Die Behandlung des AAA erfolgt in Deutschland sektorenübergreifend und interdisziplinär, wobei im stationären Sektor etwa 12.000 invasive Prozeduren zur Behandlung intakter (90 %) und rupturierter AAA stattfinden. In Übereinstimmung mit der internationalen Versorgungsrealität erfolgten dabei etwa 70 % (intakt) bzw. 30 % (rupturiert) aller Behandlungen endovaskulär (EVAR).
Die Daten aus verschiedenen administrativen und klinischen Registern zur Krankenhaussterblichkeit bestätigen mit etwa 1 % nach EVAR und bis zu 5 % nach offen-chirurgischer Behandlung des intakten AAA die Ergebnisse randomisierter Studien und Metaanalysen (26 % bzw. 42 % bei Behandlung der Ruptur).
In Deutschland werden in > 500 Krankenhäusern AAA behandelt. Eine signifikante Korrelation zwischen hoher jährlicher Fallzahl und niedriger Krankenhausletalität wurde mehrfach auf dem Boden verschiedener Datenquellen bestätigt. Eine Mindestmenge von 30 AAA-Operationen pro Jahr erscheint hinsichtlich der Erreichbarkeit von Krankenhäusern sinnvoll. Trotz der zahlreichen verfügbaren Studien und Präsenz des Themas in Fachjournalen und Kongressen sind zahlreiche Fragen weiterhin ungeklärt.
Abstract
Although there is a paucity of valid population-based data concerning the prevalence and incidence of abdominal aortic aneurysms (AAA) in Germany, national screening studies in Sweden, the USA, and England suggest a prevalence of AAA of 1.5–3.6% among males over 65 years old. The treatment of patients with AAA in Germany is provided by multiple disciplines and healthcare sectors, whereby approximately 12,000 invasive procedures to treat intact (90%) and ruptured AAA are performed annually. In line with international treatment reality 70% of intact and 30% of ruptured AAA are treated endovascularly (EVAR).
Data from various administrative and clinical registers on in-hospital mortality confirm the results from randomized trials and meta-analyses with 1% after elective EVAR through 5% after elective open repair (26% and 42% after ruptured AAA, respectively).
In Germany, more than 500 hospitals treat patients with AAA. A significant correlation between annual case volume and lower in-hospital mortality was confirmed based on various data sources. A threshold of 30 AAA repairs per year seems reasonable with respect to the accessibility of hospitals. Despite the many available studies and presence of the topic in scientific journals and scientific meetings, many questions remain unanswered to date.
Literatur
Ashton HA, Gao L, Kim LG et al (2007) Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms. Br J Surg 94:696–701
Beck AW, Sedrakyan A, Mao J et al (2016) Variations in abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation 134:1948–1958
Behrendt C‑A, Kreutzburg T, Kuchenbecker J et al (2021) Female sex and outcomes after endovascular aneurysm repair for abdominal aortic aneurysm: a propensity score matched cohort analysis. J Clin Med 10:162
Behrendt CA, Marschall U, L’Hoest H et al (2016) Current treatment of abdominal aortic aneurysms in Germany—outcomes and trends in a 5-year follow-up from registry and health insurance data. In: Greenhalgh R (Hrsg) Charing cross textbook 2016. BIBA MEDICAL, , S 1–10
Behrendt CA, Riess HC, Diener H et al (2018) Abdominal aortic aneurysm. MMW Fortschr Med 160:50–59
Behrendt CA, Riess HC, Schwaneberg T et al (2018) Incidence, predictors, and outcomes of colonic ischaemia in abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 56:507–513
Behrendt CA, Sedrakyan A, Riess HC et al (2017) Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany. J Vasc Surg 66:1704–1711.e3
Behrendt CA, Sedrakyan A, Schwaneberg T et al (2019) Impact of weekend treatment on short-term and long-term survival after urgent repair of ruptured aortic aneurysms in Germany. J Vasc Surg 69:792–799.e2
Behrendt CA, Trenner M, Kölbel T (2020) Die Sache mit den Mindestmengen und der Zentralisierung bei der Behandlung des Bauchaortenaneurysmas. Gefässchirurgie 25:462–465
Behrendt CA, Venermo M, Cronenwett JL et al (2019) VASCUNET, VQI, and the international consortium of vascular registries—unique collaborations for quality improvement in vascular surgery. Eur J Vasc Endovasc Surg 58:792–793
Budtz-Lilly J, Bjorck M, Venermo M et al (2018) Editor’s choice—the impact of centralisation and Endovascular aneurysm repair on treatment of ruptured abdominal aortic aneurysms based on international registries. Eur J Vasc Endovasc Surg 56:181–188
Castro-Ferreira R, Lachat M, Schneider PA et al (2019) Disparities in contemporary treatment rates of abdominal aortic aneurysms across western countries. Eur J Vasc Endovasc Surg 58:200–205
Cook JA, Campbell MK, Gillies K et al (2018) Surgeons’ and methodologists’ perceptions of utilising an expertise-based randomised controlled trial design: a qualitative study. Trials 19:478
Dansey KD, de Guerre LEVM, Swerdlow NJ et al (2020) Not all databases are created equal: a comparison of administrative data and quality improvement registries for abdominal aortic aneurysm repair. J Vasc Surg. https://doi.org/10.1016/j.jvs.2020.06.105
Debus ES, Heidemann F, Gross-Fengels W et al (2019) Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms. Gefässchirurgie 24:1–18
Debus ES, Torsello G, Behrendt CA et al (2015) Perioperative mortality following repair for abdominal aortic aneurysm in Germany : comparison of administrative data of the DAK health insurance and clinical registry data of the German vascular society. Chirurg 86:1041–1050
Donas KP, Scali ST (2021) “Primum non Nocere” but ultimately the goal is to “curare”: the case for a more pliable approach to abdominal aortic aneurysm repair centralisation. Eur J Vasc Endovasc Surg. https://doi.org/10.1016/j.ejvs.2020.10.035
Earnshaw JJ (2011) Doubts and dilemmas over abdominal aortic aneurysm. Br J Surg 98:607–608
Ferket BS, Spronk S, Colkesen EB et al (2012) Systematic review of guidelines on peripheral artery disease screening. Am J Med 125:198–208.e3
Flessenkämper I, Kendzia A, Stalke J (2009) Multizentrisches Screening eines arteriell vorerkrankten Patientenkollektivs in Hinblick auf die Prävalenz infrarenaler Aortenaneurysmen. Gefässchirurgie 14:376–383
Hohneck A, Keese M, Ruemenapf G et al (2019) Prevalence of abdominal aortic aneurysm and associated lower extremity artery aneurysm in men hospitalized for suspected or known cardiopulmonary disease. BMC Cardiovasc Disord 19:284
Jagodzinski A, Johansen C, Koch-Gromus U et al (2020) Rationale and design of the Hamburg City Health study. Eur J Epidemiol 35:169–181
Kuehnl A, Salvermoser M, Erk A et al (2018) Spatial analysis of hospital incidence and in hospital mortality of abdominal aortic aneurysms in Germany: secondary data analysis of nationwide hospital episode (DRG) data. Eur J Vasc Endovasc Surg 55:852–859
Kuhnl A, Erk A, Trenner M et al (2017) Incidence, treatment and mortality in patients with abdominal aortic aneurysms. Dtsch Arztebl Int 114:391–398
Kühnl A, Knipfer E, Lang T et al (2020) Krankenhausinzidenz, stationäre Versorgung und Outcome der peripheren arteriellen Verschlusskrankheit und arteriellen Thrombose/Embolie in Deutschland von 2005 bis 2018. Gefässchirurgie 25:433–445
Lederle FA (2011) The rise and fall of abdominal aortic aneurysm. Circulation 124:1097–1099
Li B, Khan S, Salata K et al (2019) A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg 70:954–969.e30
Lindholt JS, Juul S, Fasting H et al (2006) Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial. Eur J Vasc Endovasc Surg 32:9–15
Müller V, Miszczuk M, Althoff CE et al (2019) Comorbidities associated with large abdominal aortic aneurysms. Aorta 7:108–114
Mylonas SN, Brunkwall JS (2018) Was haben wir aus prospektiv randomisierten Studien über Aortenaneurysmen gelernt? Gefässchirurgie 23:331–339
Nordon IM, Hinchliffe RJ, Loftus IM et al (2011) Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 8:92–102
Norman PE, Jamrozik K, Lawrence-Brown MM et al (2004) Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 329:1259
Peters F, Kreutzburg T, Kuchenbecker J et al (2020) Quality of care in surgical/interventional vascular medicine: what can routinely collected data from the insurance companies achieve? Gefässchirurgie. https://doi.org/10.1007/s00772-020-00679-4
Reutersberg B, Salvermoser M, Haller B et al (2020) Screening cardiovascular patients for aortic aneurysms (SCAN)—high prevalence of abdominal aortic aneurysms in coronary heart disease patients requiring intervention. Vasa 49:375–381
Sakalihasan N, Michel JB, Katsargyris A et al (2018) Abdominal aortic aneurysms. Nat Rev Dis Primers 4:34
Scali ST, Beck AW, Sedrakyan A et al (2021) Optimal threshold for the volume-outcome relationship after open AAA repair in the endovascular era—analysis of the international consortium of vascular registries. Eur J Vasc Endovasc Surg. https://doi.org/10.1016/j.ejvs.2021.02.018
Scali ST, Beck AW, Sedrakyan A et al (2019) Hospital volume association with abdominal aortic aneurysm repair mortality: analysis of the international consortium of vascular registries. Circulation 140:1285–1287
Schäberle W (2020) Sonographische Bestimmung des Aortenaneurysmadurchmessers. Gefässchirurgie 25:675–689
Spanos K, Behrendt CA, Kouvelos G et al (2020) A new randomized controlled trial on abdominal aortic aneurysm repair is needed. J Vasc Surg 72:2145–2148
Spanos K, Nana P, Behrendt C‑A et al (2020) Management of abdominal aortic aneurysm disease: similarities and differences among cardiovascular guidelines and NICE guidance. J Endovasc Ther 27:889–901
Stoberock K, Riess HC, Debus ES et al (2018) Gender differences in abdominal aortic aneurysms in Germany using health insurance claims data. Vasa 47:36–42
Svensjo S, Bjorck M, Gurtelschmid M et al (2011) Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation 124:1118–1123
Swart E, Stallmann C, Schimmelpfennig M et al (2018) Gutachten zum Einsatz von Sekundärdaten für die Forschung zu Arbeit und Gesundheit
Thompson SG, Ashton HA, Gao L et al (2012) Final follow-up of the multicentre aneurysm screening study (MASS) randomized trial of abdominal aortic aneurysm screening. Br J Surg 99:1649–1656
Trenner M, Haller B, Söllner H et al (2013) 12 Jahre „Qualitätssicherung BAA“ der DGG. Gefässchirurgie 18:206–213
Trenner M, Haller B, Söllner H et al (2014) 12 Jahre Qualitätssicherung zum rupturierten und nicht rupturierten abdominalen Aortenaneurysma der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG). Gefässchirurgie 19:573–585
Trenner M, Haller B, Söllner H et al (2013) 12 Jahre „Qualitätssicherung BAA“ der DGG. Gefässchirurgie 18:372–380
Trenner M, Haller B, Storck M et al (2017) Trends in patient safety of intact abdominal aortic aneurysm repair: German registry data on 36,594 procedures. Eur J Vasc Endovasc Surg 53:641–647
Trenner M, Kuehnl A, Reutersberg B et al (2018) Nationwide analysis of risk factors for in-hospital mortality in patients undergoing abdominal aortic aneurysm repair. Br J Surg 105:379–387
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
Trenner M, Salvermoser M, Busch A et al (2020) Effect modification of sex and age for the hospital volume - outcome relationship in abdominal aortic aneurysm treatment: secondary data analysis of the nationwide German diagnosis related groups statistics from 2005 to 2014. J Am Heart Assoc 9:e14534
Trenner M, Salvermoser M, Busch A et al (2020) Mindestmengeneffekte bei der Therapie des abdominalen Aortenaneurysmas. Dtsch Arztebl Int 117:820–827
Trenner M, Salvermoser M, Reutersberg B et al (2020) Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany. Vasa 49:107–114
Venermo M, Wang G, Sedrakyan A et al (2017) Editor’s choice—carotid stenosis treatment: variation in international practice patterns. Eur J Vasc Endovasc Surg 53:511–519
Wanhainen A, Hultgren R, Linné A et al (2016) Outcome of the Swedish nationwide abdominal aortic aneurysm screening program. Circulation 134:1141–1148
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
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C.-A. Behrendt, A. Larena-Avellaneda, T. Kölbel, E.S. Debus, F. Heidemann, A. Kühnl, H.-H. Eckstein und M. Trenner geben an, dass kein Interessenkonflikt besteht.
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Behrendt, CA., Larena-Avellaneda, A., Kölbel, T. et al. Was Sie schon immer zur Behandlung des abdominalen Aortenaneurysmas in Deutschland wissen wollten: Real-World-Evidenz, Trends und offene Fragen. Gefässchirurgie 26, 252–260 (2021). https://doi.org/10.1007/s00772-021-00773-1
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DOI: https://doi.org/10.1007/s00772-021-00773-1