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Zentralbl Chir 2021; 146(05): 464-469
DOI: 10.1055/a-1618-6913
Übersicht

Pro Endo: No Need for Open Any More ... Surveillance is All Important

Pro Endo: No Need for Open Any More... Surveillance is All Important
Spyridon Mylonas
1   Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland (Ringgold ID: RIN27182)
,
Amelie Behrens
1   Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland (Ringgold ID: RIN27182)
,
Bernhard Dorweiler
2   Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland (Ringgold ID: RIN27182)
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Zusammenfassung

Seit dem ersten Bericht im Jahr 1991 hat sich die endovaskuläre Aneurysmareparatur (EVAR) von abdominellen Aortenaneurysmen (BAAs) zu einer etablierten und bevorzugten Behandlungsmethode bei vielen Patienten entwickelt. Mehrere randomisierte kontrollierte Studien zum Vergleich von EVAR und offener Rekonstruktion haben einen frühen Überlebensvorteil, eine niedrigere perioperative Morbidität und einen kürzeren Krankenhausaufenthalt mit EVAR gezeigt. Infolgedessen ist EVAR in den meisten Gefäßzentren die häufigste Methode zur elektiven Reparatur von BAAs geworden. Trotz der verbreiteten Anwendung gibt es noch immer Untergruppen des Patientenkollektivs, bei denen der Nutzen von EVAR nicht eindeutig nachgewiesen wurde. Die in diesem Zusammenhang am häufigsten diskutierten Untergruppe ist der Patient mit wenigen Risikofaktoren, wegen Bedenken hinsichtlich der Dauerhaftigkeit der Methode und dem Bedarf von Reinterventionen. EVAR kann bei diesen jüngeren Patienten Haltbarkeit und Langzeitüberleben ähnlich denen mit offener Reparatur bieten, solange die Anatomie des Aneurysmas berücksichtigt und die Gebrauchsanweisung eingehalten werden. Die Evidenz über die Auswirkungen der Nachkontrollen auf die Überlebensrate der Patienten aktuell ist umstritten Mit zunehmendem Wissen über das Verhalten von Endoprothesen und Faktoren, welche die Komplikationen des Endografts beeinflussen, kam es zu Veränderungen in der Nachsorge. Eine eher patientenspezifische Nachsorge und weniger die Einhaltung eines rigorosen Nachsorgeschemas ist gefordert.

Abstract

Since its first report in 1991, endovascular aneurysm repair (EVAR) has become an established and preferred treatment modality for many patients. Several randomised controlled trials comparing EVAR and open repair have shown an early survival benefit, lower perioperative morbidity and shorter hospital stay with EVAR. As a result, EVAR has become the most common method of elective repair of BAAs in most vascular centres. Despite its widespread use, there are still subgroups of the patient population for whom the benefit of EVAR has not been clearly demonstrated. The most frequently discussed subgroup in this context is the patient with few risk factors – due to concerns about the durability and need of reinterventions. EVAR can provide durability and long-term survival similar to open repair in these younger patients, as long as the aneurysm anatomy and instructions for use are followed. The evidence on the effects of follow-up on patient survival is currently controversial. With increasing knowledge about the behavior of endoprostheses and factors that influence the complications of the endograft, changes in follow-up protocols have been made. A more patient-specific follow-up strategy and less compliance with a rigorous follow up scheme are required.

Schlüsselwörter

endovaskuläre Therapie - Nachsorge - Langzeitergebnis - Bauchaortenaneurysma

Keywords

abdominal aortic aneurysm - Follow up - endovascular aneurysm repair


Publication History

Received: 31 July 2021

Accepted after revision: 25 August 2021

Article published online:
19 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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