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Was Sie schon immer zur Behandlung des abdominalen Aortenaneurysmas in Deutschland wissen wollten: Real-World-Evidenz, Trends und offene Fragen

What you always wanted to know about the treatment of abdominal aortic aneurysms in Germany: real-world evidence, trends and open questions

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A Kommentar to this article was published on 21 October 2021

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.

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Authors and Affiliations

  1. Forschungsgruppe GermanVasc, Deutsches Aortenzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitäres Herz- und Gefäßzentrum, UKE Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    C.-A. Behrendt, T. Kölbel, E. S. Debus & F. Heidemann

  2. Gefäß- und endovaskuläre Chirurgie, Asklepios Klinik Altona, Hamburg, Deutschland

    A. Larena-Avellaneda

  3. Münchner Aorten Centrum (MAC), Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    A. Kühnl, H.-H. Eckstein & M. Trenner

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  1. C.-A. Behrendt
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  2. A. Larena-Avellaneda
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  3. T. Kölbel
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Correspondence to C.-A. Behrendt.

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Interessenkonflikt

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.

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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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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