Wann überweisen? Wie weiter betreuen?

Das Bauchaortenaneurysma in der hausärztlichen Versorgung

Abdominal aortic aneurysm

Zusammenfassung

Aufgrund der Verwendung von Schlagwörtern wie „Silent Killer“ oder „Zeitbombe im Bauch“ in der Boulevardpresse sehen sich auch Hausärzte immer wieder mit besorgten Patienten oder deren Angehörigen konfrontiert. Dabei muss durchaus nicht jeder Patient invasiv therapiert werden. Sinnvoll sind das effiziente Screening von Risikopopulationen und eine individuelle Stufendiagnostik, die durch eine optimale konservative Therapie und befundadaptierte Überwachung komplettiert werden sollte. Erfahren Sie hier, was zu tun ist.

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Literatur

  1. 1.

    Jahangir E, Lipworth L, Edwards TL, Kabagambe EK, Mumma MT, Mensah GA, Fazio S, Blot WJ and Sampson UK. 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. Journal of epidemiology and community health. 2015;69:481–8

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Cornuz J, Sidoti Pinto C, Tevaearai H and Egger M. Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies. Eur J Public Health. 2004;14:343–9

    Article  PubMed  Google Scholar 

  3. 3.

    Lederle FA, Johnson GR, Wilson SE, Chute EP, Hye RJ, Makaroun MS, Barone GW, Bandyk D, Moneta GL and Makhoul RG. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med. 2000;160:1425–30

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Golledge J, Moxon J, Pinchbeck J, Anderson G, Rowbotham S, Jenkins J, Bourke M, Bourke B, Dear A, Buckenham T, Jones R and Norman PE. Association between metformin prescription and growth rates of abdominal aortic aneurysms. Br J Surg. 2017;104:1486–93

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Lederle FA. The rise and fall of abdominal aortic aneurysm. Circulation. 2011;124:1097–9

    Article  PubMed  Google Scholar 

  6. 6.

    Anjum A and Powell JT. Is the incidence of abdominal aortic aneurysm declining in the 21st century? Mortality and hospital admissions for England & Wales and Scotland. Eur J Vasc Endovasc Surg. 2012;43:161–6

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Svensjo S, Bjorck M and Wanhainen A. Editor’s choice: five-year outcomes in men screened for abdominal aortic aneurysm at 65 years of age: a population-based cohort study. Eur J Vasc Endovasc Surg. 2014;47:37–44

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Benson RA, Poole R, Murray S, Moxey P and Loftus IM. Screening results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols. J Vasc Surg. 2016;63:301–4

    Article  PubMed  Google Scholar 

  9. 9.

    Ulug P, Powell JT, Sweeting MJ, Bown MJ, Thompson SG and Group SC. Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women. Br J Surg. 2016;103:1097–104

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Karthikesalingam A, Holt PJ, Vidal-Diez A, Ozdemir BA, Poloniecki JD, Hinchliffe RJ and Thompson MM. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet. 2014;383:963–9

    Article  PubMed  Google Scholar 

  11. 11.

    Behrendt CA, Sedrakyan A, Riess HC, Heidemann F, Kolbel T, Petersen J and Debus ES. Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany. J Vasc Surg. 2017;66:1704–11 e3

    Article  PubMed  Google Scholar 

  12. 12.

    Kuhnl A, Erk A, Trenner M, Salvermoser M, Schmid V and Eckstein HH. Incidence, Treatment and Mortality in Patients with Abdominal Aortic Aneurysms. Dtsch Arztebl Int. 2017;114:391–98

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    DeStatis SB. Krankenhausdiagnosestatistik. 2014;2014:Gesundheitsberichterstattung des Bundes.

  14. 14.

    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ and Guidelines ESCCfP. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European heart journal. 2014;35:2873–926.

    Article  PubMed  Google Scholar 

  15. 15.

    Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlosser FJ, Setacci F, Ricco JB and European Society for Vascular S. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41(Suppl. 1):S1–S58

    Article  PubMed  Google Scholar 

  16. 16.

    Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, Mastracci TM, Mell M, Murad MH, Nguyen LL, Oderich GS, Patel MS, Schermerhorn ML and Starnes BW. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67:2–77 e2

    Article  PubMed  Google Scholar 

  17. 17.

    Marston WA, Ahlquist R, Johnson G, Jr. and Meyer AA. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg. 1992;16:17–22

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Lloyd GM, Bown MJ, Norwood MG, Deb R, Fishwick G, Bell PR and Sayers RD. Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: a time-to-death study in patients without operation. J Vasc Surg. 2004;39:788–91

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Behrendt CA, Wipper S, Debus SE, von Kodolitsch Y, Puschel K, Kammal M and Kammal A. Primary aorto-enteric fistula as a rare cause of massive gastrointestinal haemorrhage. Vasa. 2017;46:425–30

    Article  PubMed  Google Scholar 

  20. 20.

    Borgbjerg J, Bogsted M, Lindholt JS, Behr-Rasmussen C, Horlyck A and Frokjaer JB. Superior Reproducibility of the Leading to Leading Edge and Inner to Inner Edge Methods in the Ultrasound Assessment of Maximum Abdominal Aortic Diameter. Eur J Vasc Endovasc Surg. 2018;55:206–13

    Article  PubMed  Google Scholar 

  21. 21.

    Buffa V, Solazzo A, D’Auria V, Del Prete A, Vallone A, Luzietti M, Madau M, Grassi R and Miele V. Dual-source dual-energy CT: dose reduction after endovascular abdominal aortic aneurysm repair. La Radiologia medica. 2014;119:934–41

    Article  PubMed  Google Scholar 

  22. 22.

    Moos SI, van Vemde DN, Stoker J and Bipat S. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis. European journal of radiology. 2013;82:e387–99

    Article  PubMed  Google Scholar 

  23. 23.

    Marckmann P, Skov L, Rossen K, Dupont A, Damholt MB, Heaf JG and Thomsen HS. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. JASN. 2006;17:2359–62

    Article  PubMed  Google Scholar 

  24. 24.

    Twine CP and Williams IM. Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms. Br J Surg. 2011;98:346–53

    Article  PubMed  Google Scholar 

  25. 25.

    Takagi H, Yamamoto H, Iwata K, Goto S, Umemoto T and Group A. Effects of statin therapy on abdominal aortic aneurysm growth: a meta-analysis and meta-regression of observational comparative studies. Eur J Vasc Endovasc Surg. 2012;44:287–92

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, White IR, Caulfield MJ, Deanfield JE, Smeeth L, Williams B, Hingorani A and Hemingway H. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383:1899–911

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Lindholt JS and Sogaard R. Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial. Lancet. 2017;390:2256–65

    Article  PubMed  Google Scholar 

  28. 28.

    Tew GA, Moss J, Crank H, Mitchell PA and Nawaz S. Endurance exercise training in patients with small abdominal aortic aneurysm: a randomized controlled pilot study. Archives of physical medicine and rehabilitation. 2012;93:2148–53

    Article  PubMed  Google Scholar 

  29. 29.

    Kothmann E, Batterham AM, Owen SJ, Turley AJ, Cheesman M, Parry A and Danjoux G. Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: a pilot study. Br J Anaesth. 2009;103:505–10

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Kothmann E, Danjoux G, Owen SJ, Parry A, Turley AJ and Batterham AM. Reliability of the anaerobic threshold in cardiopulmonary exercise testing of patients with abdominal aortic aneurysms. Anaesthesia. 2009;64:9–13

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Tew GA, Weston M, Kothmann E, Batterham AM, Gray J, Kerr K, Martin D, Nawaz S, Yates D and Danjoux G. High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial. BMJ open. 2014;4:e004094.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW and Shen W-K. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:1425–43

    Article  PubMed  Google Scholar 

  33. 33.

    Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Jr. and Veith FJ. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg. 2009;50:880–96

    Article  PubMed  Google Scholar 

  34. 34.

    Davis M, Harris M and Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg. 2013;57:1440–5

    Article  PubMed  Google Scholar 

  35. 35.

    Thompson SG, Brown LC, Sweeting MJ, Bown MJ, Kim LG, Glover MJ, Buxton MJ and Powell JT. 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 technology assessment. 2013;17:1–118

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Collaborators R, Bown MJ, Sweeting MJ, Brown LC, Powell JT and Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA. 2013;309:806–13

    Article  Google Scholar 

  37. 37.

    Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ and Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100:863–72

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    van Schaik TG, Yeung KK, Verhagen HJ, de Bruin JL, van Sambeek M, Balm R, Zeebregts CJ, van Herwaarden JA, Blankensteijn JD and participants Dt. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2017;66:1379–89

    Article  PubMed  Google Scholar 

  39. 39.

    Patel R, Sweeting MJ, Powell JT and Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–74.

    Article  PubMed  Google Scholar 

  40. 40.

    Liang NL, Reitz KM, Makaroun MS, Malas MB and Tzeng E. Comparable perioperative mortality outcomes in younger patients undergoing elective open and endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2018;67:1404–9

    Article  PubMed  Google Scholar 

  41. 41.

    Regnier P, Lareyre F, Hassen-Khodja R, Durand M, Touma J and Raffort J. Sexual Dysfunction After Abdominal Aortic Aneurysm Surgical Repair: Current Knowledge and Future Directions. Eur J Vasc Endovasc Surg. Eur J Vasc Endovasc Surg. 2018;55:267–80

    Article  PubMed  Google Scholar 

  42. 42.

    Beck AW, Sedrakyan A, Mao J, Venermo M, Faizer R, Debus S, Behrendt CA, Scali S, Altreuther M, Schermerhorn M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Bjorck M, Cronenwett JL, Mani K and International Consortium of Vascular R. Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. Circulation. 2016;134:1948–58.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier H and Eckstein HH. 12 Jahre „Qualitätssicherung BAA“ der DGG. Gefässchirurgie. 2013;18:206–13

    Article  Google Scholar 

  44. 44.

    Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier H and Eckstein HH. 12 Jahre „Qualitätssicherung BAA“ der DGG. Gefässchirurgie. 2013;18:372–80

    Article  Google Scholar 

  45. 45.

    Hajibandeh S, Hajibandeh S, Antoniou SA, Child E, Torella F and Antoniou GA. Percutaneous access for endovascular aortic aneurysm repair: A systematic review and meta-analysis. Vascular. 2016;24:638–48

    Article  PubMed  Google Scholar 

  46. 46.

    Arnaoutoglou E, Kouvelos G, Papa N, Kallinteri A, Milionis H, Koulouras V and Matsagkas M. Prospective Evaluation of Post-implantation Inflammatory Response After EVAR for AAA: Influence on Patients’ 30 Day Outcome. European Journal of Vascular and Endovascular Surgery. 2015;49:175–83

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Karanikola E, Dalainas I, Karaolanis G, Zografos G and Filis K. Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now? The International journal of angiology: official publication of the International College of Angiology, Inc. 2014;23:155–64

    Article  Google Scholar 

  48. 48.

    Deery SE, Ergul EA, Schermerhorn ML, Siracuse JJ, Schanzer A, Goodney PP, Cambria RP, Patel VI and Vascular Study Group of New E. Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair. J Vasc Surg. 2018;67:157–64

    Article  PubMed  Google Scholar 

  49. 49.

    American College of C, American Heart Association Task Force on Practice G, American Society of E, American Society of Nuclear C, Heart Rhythm S, Society of Cardiovascular A, Society for Cardiovascular A, Interventions, Society for Vascular M, Biology, Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jr., Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL and Riegel B. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology. Journal of the American College of Cardiology. 2006;47:2343–55

    Article  Google Scholar 

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Correspondence to Dr. med. Christian-Alexander Behrendt.

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INTERESSENKONFLIKT

Die Autoren erklären, dass sie sich bei der Erstellung des Beitrages von keinen wirtschaftlichen Interessen leiten ließen. Sie legen folgende potenzielle Interessenkonflikte offen: Dr. Behrendt: keine; Prof. Kölbel: Unterstützung der Forschungs- und Vortragstätigkeiten, Patente und Royalty-Gebühren, Beratungstätigkeit und Proctoring mit Cook Medical; Prof. Debus: Institutional grants von Cook Medical und Vascutek; Prof. Larena-Avellaneda: Vortragstätigkeit für Cook Medical. Die übrigen Koautoren: keine.

Der Verlag erklärt, dass die inhaltliche Qualität des Beitrags von zwei unabhängigen Gutachtern geprüft wurde. Werbung in dieser Zeitschriftenausgabe hat keinen Bezug zur CME-Fortbildung. Der Verlag garantiert, dass die CME-Fortbildung sowie die CME-Fragen frei sind von werblichen Aussagen und keinerlei Produktempfehlungen enthalten. Dies gilt insbesondere für Präparate, die zur Therapie des dargestellten Krankheitsbildes geeignet sind.

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Behrendt, CA., Rieß, H.C., Diener, H. et al. Das Bauchaortenaneurysma in der hausärztlichen Versorgung. MMW - Fortschritte der Medizin 160, 50–59 (2018). https://doi.org/10.1007/s15006-018-0018-y

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Keywords

  • Open aortic repair (OAR)
  • ruptured aortic aneurysm
  • ultrasound screening
  • surveillance