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Aortenaneurysma

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Definition:
Dilatation der Aorta, die mit zunehmender Größe rupturieren kann.
Häufigkeit:
Männer deutlich häufiger betroffen, Prävalenz bei Männer 1,3–1,7 %.
Symptome:
In der Regel asymptomatisch.
Befunde:
Evtl. pulsierende Resistenz im Bauch palpabel.
Diagnostik:
Abdominalsonografie bzw. Echokardiografie. Ein sonografisches Screening auf ein AAA sollte allen männlichen Patienten > 65 Jahre angeboten werden.
Therapie:
Abhängig von Größe und Risikofaktoren regelmäßige Überwachung, OP oder Stent.
  • European Society of Cardiology. Guidelines on the diagnosis and treatment of aortic diseases, Stand 2015. www.escardio.org 
  • Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG). Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas. AWMF-Leitlinie 004-014. S3, Stand 2018. www.awmf.org 
  1. Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet 2005; 365: 1577-89. PubMed  
  2. Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG). S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas. AWMF-Leitlinie 004-014. Stand 2018. www.awmf.org  
  3. Kniemeyer HW, Kessler T, Reber PU, Ris HB, Hakki H and Widmer MK. Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score. Eur J Vasc Endovasc Surg 2000; 19: 190-6. PubMed  
  4. Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121: 266-369. pubmed.ncbi.nlm.nih.gov  
  5. Anjum A, Powell JT. Is theincidence 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. pubmed.ncbi.nlm.nih.gov  
  6. Benson RA, Poole R, Murray S, et al. Screening resultsfrom 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. pubmed.ncbi.nlm.nih.gov  
  7. Ashton HA, Gao L, Kim LG, et al. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms. Br J Surg 2007; 94: 696-701. pubmed.ncbi.nlm.nih.gov  
  8. Khashram M, Jones GT, Roake JA. Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. Eur J Vasc Endovasc Surg 2015; 50: 199-205. pubmed.ncbi.nlm.nih.gov  
  9. Lavall D, Schäfers HJ, Böhm M, et al. Aneurysmen der Aorta ascendens. Dtsch Arztebl Int 2012; 109(13): 227-33. www.aerzteblatt.de  
  10. Stather PW, Sidloff DA, Dattani N, et al. Meta-analysis and meta-regression analysis of biomarkers for abdominal aortic aneurysm. Br. J. Surg 2014; 101: 1358–1372. pubmed.ncbi.nlm.nih.gov  
  11. Altobelli E, Rapacchietta L, Profeta VF, et al. Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2018; 15(12): 2805. www.ncbi.nlm.nih.gov  
  12. Lee CC, Lee MG, Cheng YS et al. Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Intern Med. doi:10.1001/jamainternmed.2015.5389. www.ncbi.nlm.nih.gov  
  13. Gopalakrishnan C, Bykov K, Fischer MA, Connolly JG, Gagne JJ, Fralick M. Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection. JAMA Intern Med. 2020. PMID: 32897307. pubmed.ncbi.nlm.nih.gov  
  14. Upchurch GR, Schaub TA. Abdominal aortic aneurysm. Am Fam Physician 2006; 73: 1198-204. PubMed  
  15. Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB and Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 2000; 160: 833-6. PubMed  
  16. Cosford P, Leng G. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev, issue 2, 2007. www.cochrane.org  
  17. Ali MU, Fitzpatrick-Lewis D, Miller J, et al. Screening for abdominal aortic aneurysm in asymptomatic adults. J Vasc Surg 2016; 64(6): 1855-1868. pmid:27871502 PubMed  
  18. Metcalfe D, Holt PJE, Thompson MM. The management of abdominal aortic aneurysms. BMJ 2011; 342: d1384. BMJ (DOI)  
  19. Thompson SG, Ashton HA, Gao L, et al. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 2009; 338: b2307. BMJ (DOI)  
  20. Wanhainen A, Hultgren R, Linné A et al. Outcome of the Swedish nationwide abdominal aortic aneurysm screening program. Circulation 2016;134:1141. www.ncbi.nlm.nih.gov  
  21. LeFevre M für die USPSTF. Screening for abdominal aortic aneurysm: U.S. preventive services task force recommendation statement Ann Intern Med. doi:10.7326/M14-1204. annals.org  
  22. The UK Small Aneurysm Trial Participants. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998; 352: 1649-55 PubMed  
  23. European Society of Cardiology. Guidelines on the diagnosis and treatment of aortic diseases, Stand 2015. www.escardio.org  
  24. Lederle FA (ed). Abdominal aortic aneurysm - open versus endovascular repair. N Engl J Med 2004; 351: 1677-9. New England Journal of Medicine  
  25. Dimick JB, Cowan JA, Stanley JC, Henke PK, Pronovost PJ, Upchurch GR. Surgeon speciality and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States. J Vasc Surg 2003; 38: 739 - 44. PubMed  
  26. Holt PJ, Poloniecki JD, Gerrard D, Loftus IM, Thompson MM. Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery. Br J Surg 2007; 94: 395-403. PubMed  
  27. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM and Powell JT. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 2004; 110: 16-21. pubmed.ncbi.nlm.nih.gov  
  28. Coggia M, JaverliatI, Centa Di et al. Total laparoscopic infrarenal aortic aneurysm repair: preliminary results. J Vasc Surg 2004; 40: 448-54. PubMed  
  29. Jordan WD, Alcocer F, Wirthlin DJ, Westfall AO, Whitley D. Abdominal aortic aneurysms in "high-risk" surgical patients: comparison of open and endovascular repair. Ann Surg 2003;237: 623-9. PubMed  
  30. Prinssen M, Verhoeven EL, Buth J et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351: 1607-18. New England Journal of Medicine  
  31. Greenhalgh RM, Brown LC, Kwong GP et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364: 843-8. PubMed  
  32. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365: 2179-86. PubMed  
  33. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005; 365: 2187-92. PubMed  
  34. The United Kingdom EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1863-71. PubMed  
  35. Schermerhorn ML, O'Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysm in the medicare population. N Engl J Med 2008; 358: 464-74. New England Journal of Medicine  
  36. Rahimi SA. Abdominal Aortic Aneurysm. Medscape, last updated Jan 08, 2019. emedicine.medscape.com  
  • Lino Witte, Dr. med., Arzt in Weiterbildung, Innere Medizin, Frankfurt
  • Günther Egidi, Dr. med., Arzt für Allgemeinmedizin, Bremen (Review)

Frühere Autoren

  • Torbjørn Dahl, överläkare på kirurgavdelningen, St. Olavs Hospital i Trondheim