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

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

• Literatur

• 1 Volodos NL, Karpovich IP, Troyan VI. et al. Clinical experience of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for aorta reconstruction. Vasa Suppl 1991; 33: 93-95 (PMID: 1788781)
• 2 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5: 491-499 DOI: 10.1007/BF02015271. (PMID: 1837729)
• 3 Collin J, Murie JA. Endovascular treatment of abdominal aortic aneurysm: a failed experiment. Br J Surg 2001; 88: 1281-1282 DOI: 10.1046/j.0007-1323.2001.01907.x. (PMID: 11578279)
• 4 Kolh P, De Hert S, De Rango P. The Concept of Risk Assessment and Being Unfit for Surgery. Eur J Vasc Endovasc Surg 2016; 51: 857-866 DOI: 10.1016/j.ejvs.2016.02.004. (PMID: 27053098)
• 5 Patterson BO, Holt PJ, Hinchliffe R. et al. Predicting risk in elective abdominal aortic aneurysm repair: a systematic review of current evidence. Eur J Vasc Endovasc Surg 2008; 36: 637-645 DOI: 10.1016/j.ejvs.2008.08.016. (PMID: 18922709)
• 6 Boyle JR, Mao J, Beck AW. et al. Editor’s Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010–2016. Eur J Vasc Endovasc Surg 2021; 62: 16-24 DOI: 10.1016/j.ejvs.2021.03.034. (PMID: 34144883)
• 7 EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365: 2179-2186 DOI: 10.1016/S0140-6736(05)66627-5. (PMID: 15978925)
• 8 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: 1607-1618 DOI: 10.1056/NEJMoa042002. (PMID: 15483279)
• 9 Lederle FA, Freischlag JA, Kyriakides TC. et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302: 1535-1542 DOI: 10.1001/jama.2009.1426. (PMID: 19826022)
• 10 Jean-Pierre B. The ACE trial: A randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. J Vasc Surg 2009; 50: 222-224
• 11 Brown LC, Greenhalgh RM, Howell S. et al. Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials. Br J Surg 2007; 94: 709-716 DOI: 10.1002/bjs.5776. (PMID: 17514695)
• 12 Baas AF, Janssen KJ, Prinssen M. et al. The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial. J Vasc Surg 2008; 47: 277-281 DOI: 10.1016/j.jvs.2007.10.018.
• 13 Lederle FA, Freischlag JA, Kyriakides TC. et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 2012; 367: 1988-1997 DOI: 10.1056/NEJMoa1207481. (PMID: 23171095)
• 14 Liang NL, Reitz KM, Makaroun MS. et al. Comparable perioperative mortality outcomes in younger patients undergoing elective open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2018; 67: 1404-1409.e2 DOI: 10.1016/j.jvs.2017.08.057. (PMID: 29097041)
• 15 Trenner M, Kuehnl A, Reutersberg B. et al. Nationwide analysis of risk factors for in-hospital mortality in patients undergoing abdominal aortic aneurysm repair. Br J Surg 2018; 105: 379-387 DOI: 10.1002/bjs.10714. (PMID: 29417985)
• 16 Patel R, Sweeting MJ, Powell JT. et al. 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: 2366-2374 DOI: 10.1016/S0140-6736(16)31135-7.
• 17 De Bruin JL, Baas AF, Buth J. et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1881-1889 DOI: 10.1056/NEJMoa0909499. (PMID: 20484396)
• 18 Lederle FA, Kyriakides TC, Stroupe KT. et al. Open versus Endovascular Repair of Abdominal Aortic Aneurysm. N Engl J Med 2019; 380: 2126-2135 DOI: 10.1056/NEJMoa1715955. (PMID: 31141634)
• 19 Becquemin JP, Pillet JC, Lescalie F. et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg 2011; 53: 1167-1173.e1 DOI: 10.1016/j.jvs.2010.10.124. (PMID: 21276681)
• 20 Powell JT, Sweeting MJ, Ulug P. et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 2017; 104: 166-178 DOI: 10.1002/bjs.10430. (PMID: 28160528)
• 21 Prinssen M, Buskens E, de Jong SE. et al. Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms: results of a randomized trial. J Vasc Surg 2007; 46: 883-890 DOI: 10.1016/j.jvs.2007.07.033. (PMID: 17980274)
• 22 Stroupe KT, Lederle FA, Matsumura JS. Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. et al. Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysm in the OVER trial. J Vasc Surg 2012; 56: 901-909.e2 DOI: 10.1016/j.jvs.2012.01.086. (PMID: 22640466)
• 23 Stather PW, Sidloff D, Dattani N. et al. 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: 863-872 DOI: 10.1002/bjs.9101. (PMID: 24037583)
• 24 Chaikof EL, Dalman RL, Eskandari MK. et al. 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 DOI: 10.1016/j.jvs.2017.10.044.
• 25 Wanhainen A, Verzini F, Van Herzeele. et al. 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 2019; 57: 8-93 DOI: 10.1016/j.ejvs.2018.09.020. (PMID: 30528142)
• 26 Schanzer A, Greenberg RK, Hevelone N. et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011; 123: 2848-2855 DOI: 10.1161/CIRCULATIONAHA.110.014902. (PMID: 21478500)
• 27 Columbo JA, Ramkumar N, Martinez-Camblor P. et al. Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative. J Vasc Surg 2020; 71: 799-805.e1 DOI: 10.1016/j.jvs.2019.05.057.
• 28 Lee K, Tang E, Dubois L. et al. Durability and survival are similar after elective endovascular and open repair of abdominal aortic aneurysms in younger patients. J Vasc Surg 2015; 61: 636-641 DOI: 10.1016/j.jvs.2014.10.012. (PMID: 25457459)
• 29 Debus ES. S3-Leitlinie zum Screening, Diagnostik Therapie und Nachsorge des Bauchaortenaneurysmas. Gefässchirurgie 2018; 23: 402-403 DOI: 10.1007/s00772-018-0452-2.
• 30 Grima MJ, Boufi M, Law M. et al. Editor’s Choice – The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2018; 55: 492-502 DOI: 10.1016/j.ejvs.2017.11.030. (PMID: 29307756)
• 31 de Mik SML, Geraedts ACM, Ubbink DT. et al. Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis. J Endovasc Ther 2019; 26: 531-541 DOI: 10.1177/1526602819852085. (PMID: 31140361)
• 32 Hicks CW, Zarkowsky DS, Bostock IC. et al. Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes. J Vasc Surg 2017; 65: 1625-1635 DOI: 10.1016/j.jvs.2016.10.106. (PMID: 28216362)
• 33 Markar SR, Vidal-Diez A, Sounderajah V. et al. A population-based cohort study examining the risk of abdominal cancer after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2019; 69: 1776-1785.e2 DOI: 10.1016/j.jvs.2018.09.058. (PMID: 30583890)
• 34 Norman PE, Semmens JB, Lawrence-Brown MM. Long-term relative survival following surgery for abdominal aortic aneurysm: a review. Cardiovasc Surg 2001; 9: 219-224 DOI: 10.1016/s0967-2109(00)00126-5. (PMID: 11336844)
• 35 Batt M, Staccini P, Pittaluga P. et al. Late survival after abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 1999; 17: 338-342 DOI: 10.1053/ejvs.1998.0779. (PMID: 10204057)