Download PDF
Kardiologie up2date 2010; 6(2): 119-140
DOI: 10.1055/s-0030-1255535
Aortenerkrankungen

© Georg Thieme Verlag KG Stuttgart · New York

Abdominelle Aortenaneurysmen

Eike  Sebastian  Debus, Tilo  Kölbel, D.  Böckler, H.-H.  Eckstein
Further Information

Publication History

Publication Date:
06 July 2010 (online)

Also available at
    Permissions and Reprints All articles of this category

Abstract

As a rule aneurysms develop slowly from small to rupture imminent aneurysms. In 80 % of cases they remain free of symptoms and in the majority of cases are therefore only discovered by chance. Women are 4 – 5 times less likely to be affected than men. Clinically relevant aneurysms with a diameter of more than 5 cm occur in 1 % of males under 64 years old. The prevalence increases to 2 – 4 % wih increasing age accompanied by increased comorbidity. The underlying reasons for the development of abdominal aortic aneurysms (AAA) are in most cases unclear. Aneurysms which occur in the infrarenal aorta and also in other locations often have a genetic background and an increased familial occurrence. The prognosis of a ruptured AAA is extremely poor with a hospital fatality rate of 55 % and a total lethality of > 80 % because only some of the patients reach hospital alive. The letality associated with AAA can be reduced by establishing an ultrasound screening program by which AAA can be cost-effectively diagnosed with high reliability, sensitivity and specificity. Routine investigations should include the anterior-posterior measurement, determination of the longitudinal and transverse size as well as a topographical representation of the important efferent vessels. A medical, conservative therapy can be important for patients with small or medium sized aneurysms. The only valid measure against an impending AAA rupture is elective surgical treatment which can be carried out via an open repair of the abdominal aorta with a tube or bifurcated graft or by implantation of a stent-graft. Suitable patient selection and determination of the ideal timing for surgery are based on identification of patients with a special risk of rupture. The value of both procdures has not yet been clearly defined and requires a differentiated diagnosis of the indications.

Kernaussagen

  • Aneurysmen entwickeln sich in der Regel langsam von kleinen zu rupturgefährdeten Aneurysmen. Sie bleiben in über 80 % der Fälle klinisch symptomfrei und werden deshalb meist nur zufällig entdeckt. Frauen sind 4- bis 5-mal seltener betroffen als Männer.

  • Klinisch bedeutsame Aneurysmen mit einem Querdurchmesser von mehr als 5 cm kommen bei 1 % der Männer unter 64 Jahren vor. Mit zunehmendem Alter steigt die Prävalenz auf 2 – 4 % an, vergesellschaftet mit einer erhöhten Komorbidität.

  • Die zugrunde liegenden Ursachen für die Entwicklung eines AAA sind in den meisten Fällen unklar. Aneurysmen, die neben der infrarenalen Aorta auch an anderen Lokalisationen auftreten, haben oft eine genetische Ursache und treten familiär gehäuft auf.

  • Die Prognose des rupturierten AAA ist mit einer Krankenhausletalität von 55 % extrem schlecht. Die Gesamtletalität liegt bei > 80 %, da nur ein Teil der Patienten das Krankenhaus lebend erreicht.

  • Die AAA-assoziierte Letalität kann durch die Etablierung eines Ultraschall-Screening-Programms gesenkt werden, mit dessen Hilfe abdominelle Aortenaneurysmen kosteneffizient und mit hoher Reliabilität, Sensitivität und Spezifität diagnostiziert werden können. Die Routineuntersuchung sollte die anterior-posteriore Ausmessung, die longitudinale und transversale Größenbestimmung sowie die topografische Darstellung zu den wichtigen abgehenden Gefäßen beinhalten.

  • Eine medikamentöse und konservative Therapie kann bei Patienten mit kleinen bis mittleren Aneurysmen von Bedeutung sein. Die einzige valide Maßnahme gegen eine drohende AAA-Ruptur ist die elektive operative Therapie des AAA. Sie ist durch einen offenen Ersatz der abdominellen Aorta mittels Rohr- oder Bifurkationsprothese oder durch die Implantation einer Stentprothese möglich. Die adäquate Patientenselektion und die Festlegung des idealen Operationszeitpunkts basiert auf der Identifizierung von Patienten mit einem besonderen Rupturrisiko.

  • Der Stellenwert beider Verfahren ist noch nicht klar definiert und erfordert eine differenzierte Indikationsstellung.

Literatur

  • 1 Aboulafia D M, Aboulafia E D. Aortic aneurysm-induced disseminated intravascular coagulation.  AnnVasc Surg. 1996;  10 396-0
    PubMedGoogle Scholar
  • 2 AbuRahma A F, Campbell J, Stone P A. et al . The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients.  JVasc Surg. 2009;  50 738-748
    PubMedGoogle Scholar
  • 3 Adriaensen M E, Bosch J L, Halpern E F. et al . Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results.  Radiology. 2002;  224 739-747
    CrossrefPubMedGoogle Scholar
  • 4 Ahlers O. et al . Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery.  Br J Anaesth. 2008;  101 781-787
    CrossrefPubMedGoogle Scholar
  • 5 Allardice J T, Allwright G J, Wafula J. High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: Screening by ultrasonography.  Br J Surg. 1988;  75 240
    CrossrefPubMedGoogle Scholar
  • 6 Apfel C C. et al . Übelkeit und Erbrechen in der postoperativen Phase.  Anaesthesist. 2007;  56 1170-1180
    CrossrefPubMedGoogle Scholar
  • 7 Ashton H A, Buxton M J, Day N E. et al . The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.  Lancet. 2002;  360 1531-1539
    CrossrefPubMedGoogle Scholar
  • 8 Ashton H A, Gao L, Kim L G. 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
    CrossrefPubMedGoogle Scholar
  • 9 Baxter B T, Terrin M C, Dalman R L. Medical management of small abdominal aortic aneurysms.  Circulation. 2008;  117 1883-1889
    CrossrefPubMedGoogle Scholar
  • 10 Bengtsson H, Ekberg O, Aspelin P. et al . Ultrasound screening of the abdominal aorta in patients with intermittent claudication.  Eur J Vasc Surg. 1989;  3 497
    CrossrefPubMedGoogle Scholar
  • 11 Berg P, Kaufmann D, van Marrewijk C J, Buth J. Spinal cord ischaemia after stentgraft treatment for infrarenal abdominal aortic aneurysms. Analysis of the Eurostar database.  Eur JVasc Endovasc Surg. 2001;  22 342-347
    CrossrefPubMedGoogle Scholar
  • 12 Birkmeyer J D, Siewers A E, Finlayson E V. et al . Hospital volume and surgical mortality in the United States.  N Engl J Med. 2002;  346 1128
    CrossrefPubMedGoogle Scholar
  • 13 Bjorck M, Troeng T, Bergqvist D. Risk factors for intestinal ischaemia after aortoiliac surgery: a combined cohort and case control study of 2824 operations.  Eur JVasc Endovasc Surg. 1997;  13 531-539
    PubMedGoogle Scholar
  • 14 Blum U, Voshage G, Lammer J. et al . Endoluminal stentgrafts for infrarenal abdominal aortic aneurysms.  N Engl J Med. 1997;  336 13
    CrossrefPubMedGoogle Scholar
  • 15 Böckler D, Debus E S, Eckstein H-H. et al . Randomiserte Studien mit EBM Level 1 beweisen es: ein Screening-Programm für abdominelle Aortenaneurysmen ist sinnvoll!.  Gefäßchirurgie. 2009;  14 350-361
    CrossrefPubMedGoogle Scholar
  • 16 Boijsen E. Anomalies and malformations. In: Baum S (ed) Abrams Angiography. Boston; Little, Brown 1997: 1217
    PubMedGoogle Scholar
  • 17 Brady A R, Thompson S G, Fowkes F G. et al . Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance.  Circulation. 2004;  110 16-21
    CrossrefPubMedGoogle Scholar
  • 18 Buth J. Success of endovascular repair of abdominal aortic aneurysms and the presence of endoleak. In: Veith FJ (ed) Endoleaks & Endotension. New York; Marcel Dekker 2003
    PubMedGoogle Scholar
  • 19 Buth J HP. Endovascular Treatment of Aortic Aneurysms. In: Rutherford R (ed) Vascular surgery. 6th edn. Philadelphia; Elsevier Saunders 2005
    PubMedGoogle Scholar
  • 20 Cabellon Jr S, Moncrief C L, Pierre D R. et al . Incidence of abdominal aortic aneurysms in patients with atheromatous arterial disease.  Am J Surg. 1983;  146 575
    CrossrefPubMedGoogle Scholar
  • 21 Cavallaro A, Sapienza P, diMarzo L. et al . Inflammatory aneurysm of the abdominal aorta. Study of 355 patients with aortic aneurysm.  Recenti Prog Med. 2001;  92 269
    PubMedGoogle Scholar
  • 22 Cochennec F, Becquemin J P, Desgranges P. et al . Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence.  Eur JVasc Endovasc Surg. 2007;  34 59-65
    PubMedGoogle Scholar
  • 23 Conrad M F, Adams A B, Guest J M. et al . Secondary intervention after endovascular abdominal aortic aneurysm repair.  Ann Surg. 2009;  250 383-389
    PubMedGoogle Scholar
  • 24 Creager M A, Halperin J L, Whittemore A D. Aneurysmal disease of the aorta and its branches. In: Loscalzo J, Creager MA, Dzau VJ (eds) Vascular Medicine. New York; Little, Brown 1996: 901
    PubMedGoogle Scholar
  • 25 Criado F J, Wilson E P, Fairman R M. et al . Update on theTalent aortic stent-graft: a preliminary report from United States phase I and II trials.  J Vasc Surg. 2001;  33 146
    CrossrefPubMedGoogle Scholar
  • 26 Darling R C, Messina C R, Brewster D C. et al . Autopsy study of unoperated abdominal aortic aneurysms.The case for early resection.  Circulation. 1977;  56 (Suppl) II-161
    PubMedGoogle Scholar
  • 27 Davidian M, Bebebati J, Powell A. Endovascular grafts for the treatment of abdominal aortic aneurysms: Development of stent grafts, design of devices, and technical results. In: Dolmatch B, Blum U (eds) Stent grafts?. New York; Current Clinical Practice, Thieme 2000: 55
    PubMedGoogle Scholar
  • 28 Debus E S, Kruska P, Ivoghli A, Kerner T. Fast-track in der Gefäßchirurgie.  Chirurg. 2009;  80 711-718
    CrossrefPubMedGoogle Scholar
  • 29 Dias N V, Ivancev K, Kölbel T. et al . Intraaneurysm sac pressure in patients with unchanged AAA diameter after EVAR.  Eur JVasc Endovasc Surg. 2010;  39 35-41
    PubMedGoogle Scholar
  • 30 Dimick J B, Cowan Jr J A, Stanley J C. et al . Surgeon specialty and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States.  J Vasc Surg. 2003;  38 739
    CrossrefPubMedGoogle Scholar
  • 31 Eckstein H H, Böckler D, Flessenkämper I. et al . Ultraschall-Screening abdomineller Aortenaneurysmen (AAA).  DÄB. 2009;  106 657-663
    PubMedGoogle Scholar
  • 32 Elkouri S, Gloviczki P, McKusick M A. et al . Endovascular repair of abdominal aortic aneurysms: Initial experience with 100 consecutive patients.  Mayo Clin Proc. 2003;  78 1234
    CrossrefPubMedGoogle Scholar
  • 33 Elzouki A N, Ryden A A, Lanne T. et al . Is there a relationship between abdominal aortic aneurysms and a1-antitrypsin deficiency (PiZ)?.  Eur J Vasc Endovasc Surg. 1999;  17 149-154
    CrossrefPubMedGoogle Scholar
  • 34 Fichtner-Feigl S t, Larena-Avellaneda A, Debus E S. Überleben, Komplikationen und Risikofaktoren von rupturierten abdominalen Aortenaneurysmen. Eine retrospektive Analyse amWürzburger Krankengut.  Gefässchirurgie. 2003;  8 200-205
    CrossrefPubMedGoogle Scholar
  • 35 Fisher Jr D F, Yawn D H, Crawford E S. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. A prospective study of 76 cases.  Arch Surg. 1983;  118 1252
    PubMedGoogle Scholar
  • 36 Fleming C, Whitlock E P, Beil T L, Lederle F A. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive ServicesTask Force.  Ann Intern Med. 2005;  142 203-211
    CrossrefPubMedGoogle Scholar
  • 37 Gadowski G R, Pilcher D B, Ricci M A. Abdominal aortic aneurysm expansion rate: Effect of size and beta-adrenergic blockade.  J Vasc Surg. 1994;  19 727
    CrossrefPubMedGoogle Scholar
  • 38 Gan T. et al . Goal-directed intraoperative fluid administration reduces the length of hospital stay after major surgery.  Anesthesiology. 2002;  97 820-826
    CrossrefPubMedGoogle Scholar
  • 39 Gelfand D V, White G H, Wilson S E. Clinical significance of type II endoleak after endovascular repair of abdominal aortic aneurysm.  AnnVasc Surg. 2006;  20 69-74
    CrossrefPubMedGoogle Scholar
  • 40 Gemeinsamer Bundeasusschuss (GBA) .Qualitätssicherungsvereinbarung zum Bauchaortenaneurysma. http://www.g-ba.de/informationen/beschluesse/zur-richtlinie/65 2008
    PubMedGoogle Scholar
  • 41 Gleeson T G, Bulugahapitiya S. Contrast-induced nephropathy.  AJR Am J Roentgenol. 2004;  183 1673-1689
    CrossrefPubMedGoogle Scholar
  • 42 Golledge J, Muller J, Daugherty A, Norman P. Abdominal aortic aneurysm: pathogenesis and implications for management.  Arterioscler Thromb Vasc Biol. 2006;  26 2605-2613
    CrossrefPubMedGoogle Scholar
  • 43 Golledge J, Tsao P S, Dalman R L, Norman P E. Circulating markers of abdominal aortic aneurysm presence and progression.  Circulation. 2008;  118 2382- 2392
    CrossrefPubMedGoogle Scholar
  • 44 Gordon J R, Wahls T, Carlos R C. et al . Failureto recognize newly identified aortic dilations in a health care system with an advanced electronic medical record.  Ann Intern Me. 2009;  151 21
    PubMedGoogle Scholar
  • 45 Graham M, Chan A. Ultrasound screening for clinically occult abdominal aortic aneurysm.  CMAJ. 1988;  0 0
    PubMedGoogle Scholar
  • 46 Gralla O. et al . Fast-track bei laparoskopisch radikaler Prostatektomie.  Urologe. 2008;  47 712-717
    CrossrefPubMedGoogle Scholar
  • 47 Greenberg R K, Chuter T A, Lawrence-Brown M. et al . Analysis of renal function after aneurysm repair with a device using suprarenal fixation (Zenith AAA Endovascular Graft) in contrast to open surgical repair.  J Vasc Surg. 2004;  39 1219-1228
    CrossrefPubMedGoogle Scholar
  • 48 Greenhalgh R M, Brown L C, Kwong G P. 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
    CrossrefPubMedGoogle Scholar
  • 49 Gregor J I. et al . Fast-track-Rehabilitation in der Thoraxchirurgie.  Chirurg. 2008;  79 657-664
    CrossrefPubMedGoogle Scholar
  • 50 Harris P L, Vallabhaneni S R, Desgranges P. et al . Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on stent/graft techniques for aortic aneurysm repair.  J Vasc Surg. 2000;  32 739
    CrossrefPubMedGoogle Scholar
  • 51 Hausel J. et al . Randomized clinical trial of the effects of oral preoperative carbohydrates on post-operative nausea and vomiting after laparoscopic cholecystectomy.  Br J Surg. 2005;  92 415-421
    CrossrefPubMedGoogle Scholar
  • 52 Hedayati N, Lin P H, Lumsden A B, Zhou W. Prolonged renal artery occlusion after endovascular aneurysm repair: endovascular rescue and renal function salvage.  J Vasc Surg. 2008;  47 446-449
    CrossrefPubMedGoogle Scholar
  • 53 Hirsch A T, Haskal Z J, Hertzer N R. et al . ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association forVascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society forVascular Nursing; Trans Atlantic Inter-Society Consensus; and Vascular Disease Foundation.  Circulation. 2006;  113 e463-e654
    CrossrefPubMedGoogle Scholar
  • 54 Holt P J, Poloniecki J D, Gerrard D. et al . Metaanalysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery.  Br J Surg. 2007;  94 395-403
    CrossrefPubMedGoogle Scholar
  • 55 Holt P J, Poloniecki J D, Hofman D. et al . Re-interventions, readmissions and discharge destination: modern metrics fort he assessment of the quality of care.  Eur J Vasc Endovasc Surg. 2010;  39 49-54
    CrossrefPubMedGoogle Scholar
  • 56 Holte K. et al . Liberal versus restrictive fluid management in knee arthroplasty: a randomized, double-blind study.  Anesth Analg. 2007;  105 465-474
    Google Scholar
  • 57 Howell M H, Strickman N, Mortazavi A. et al . Preliminary results of endovascular abdominal aortic aneurysm exclusion with the AneuRx stent-graft.  J Am Coll Cardiol. 2001;  38 1040
    CrossrefPubMedGoogle Scholar
  • 58 Isselbacher E M. Thoracic and abdominal aortic aneurysms.  Circulation. 2005;  111 816
    CrossrefPubMedGoogle Scholar
  • 59 Ivoghli A, Kruska P, Kerner T. et al . Der Stellenwert minimal-invasiver Operationstechniken im Fast-track-Konzept für die Gefäßmedizin.  Gefässchirurgie. 2010;  (in Druck)
    PubMedGoogle Scholar
  • 60 Kehlet H. et al . Anesthesia, Surgery and challenges in postoperative recovery.  Lancet. 2003;  362 1921-1928
    CrossrefPubMedGoogle Scholar
  • 61 Kent K C, Zwolak R M, Jaff M R. et al . Screening for abdominal aortic aneurysm: a consensus statement.  J Vasc Surg. 2004;  39 267-269
    CrossrefPubMedGoogle Scholar
  • 62 Kertai M D, Boersma E, Westerhout C M. et al . Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery.  Am J Med. 2004;  116 96-0
    CrossrefPubMedGoogle Scholar
  • 63 Kim L G, RAPS , Ashton H A, Thompson S G. Multicentre Aneurysm Screening Study Group . A sustained mortality benefit from screening for abdominal aortic aneurysm.  Ann Intern Med. 2007;  146 699-706
    PubMedGoogle Scholar
  • 64 Kndatzen B. The Guidant/EVT Ancure device.  J Vasc Interv Radiol. 2000;  11 62
    PubMedGoogle Scholar
  • 65 Kölbel T, Debus E S. Komplikationen nach endovaskulärer Aneurysmabehandlung (EVAR).  Zbl Chir. 2010;  (in Druck)
    PubMedGoogle Scholar
  • 66 Kuivaniemi H, Tromp G, Prockop D J. Genetic causes of aortic aneurysms. Unlearning at least part of what the textbooks say.  J Clin Invest. 1991;  88 1441
    CrossrefPubMedGoogle Scholar
  • 67 LaRoy L L, Cormier P J, Matalon T A. et al . Imaging of abdominal aortic aneurysms.  AJR Am J Roentgenol. 1989;  152 785
    PubMedGoogle Scholar
  • 68 Lederle F A, Simel D L. Does this patient have abdominal aortic aneurysm?.  JAMA. 1999;  281 77-0
    CrossrefPubMedGoogle Scholar
  • 69 Lederle F A, Wilson S E, Johnson G R. et al . Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group.  J Vasc Surg. 1995;  21 945-952
    CrossrefPubMedGoogle Scholar
  • 70 Lederle F A, Johnson G R, Wilson S E. et al . Prevalence and associations of abdominal aortic aneurysm detected through screening.  Ann Intern Med. 1997;  126 441-449
    CrossrefPubMedGoogle Scholar
  • 71 Lederle F A, Johnson G R, Wilson S E. et al . 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 1425-1430
    CrossrefPubMedGoogle Scholar
  • 72 Lederle F A, Wilson S E, Johnson G R. et al . Immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med. 2002;  346 1437-1444
    CrossrefPubMedGoogle Scholar
  • 73 Lederle F A, Johnson G R, Wilson S E. et al . Quality of life, impotence, and activity level in a randomized trial of immediate repair versus surveillance of small abdominal aortic aneurysm.  J Vasc Surg. 2003;  38 745-752
    CrossrefPubMedGoogle Scholar
  • 74 Lederle F A, Kane R L, MacDonald R, Wilt T J. Systematic review: repair of unruptured abdominal aortic aneurysm.  Ann Intern Med. 2007;  146 735-741
    PubMedGoogle Scholar
  • 75 Lee E S, Pickett E, Hedayati N. et al . Implementation of an aortic screening program in clinical practice: Implications for the Screen for Abdominal Aortic AneurysmsVery Efficiently (SAAAVE).  Act J Vasc Surg. 2009; 
    PubMedGoogle Scholar
  • 76 Limet R, Sakalihassan N, Albert A. Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms.  J Vasc Surg. 1991;  14 540-548
    CrossrefPubMedGoogle Scholar
  • 77 Lindholt J S, Norman P. Screening for abdominal aortic aneurysm reduces overall mortality in men. A metaanalysis of the mid- and long-term effects of screening for abdominal aortic aneurysms.  Eur J Vasc Endovasc Surg. 2008;  36 167-171
    CrossrefPubMedGoogle Scholar
  • 78 Lindholt J S, Juul S, Fasting H, Henneberg E W. Screening for abdominal aortic aneurysms: single centre randomised controlled trial.  BMJ. 2005;  330 750
    CrossrefPubMedGoogle Scholar
  • 79 Lindholt J S, Juul S, Fasting H, Henneberg E W. Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial.  Eur JVasc Endovasc Surg. 2006;  32 9-15
    CrossrefPubMedGoogle Scholar
  • 80 Lindholt J S, Juul S, Henneberg E W. High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial.  Eur J Vasc Endovasc Surg. 2007;  34 53-58
    CrossrefPubMedGoogle Scholar
  • 81 Lindholt J S, Vammen S, Fasting H. et al . The plasma level of matrix metalloproteinase 9 may predict the natural history of small abdominal aortic aneurysms. A preliminary study.  Eur JVasc Endovasc Surg. 2000;  20 281-285
    PubMedGoogle Scholar
  • 82 Liu S S. et al . Effect of postoperative analgesia on major postoperative complications. A systematic update of the evidence.  Anesth Analg. 2007;  104 689-702
    CrossrefPubMedGoogle Scholar
  • 83 Macsweeney S T, Powell J T, Greenhalgh R M. Pathogenesis of abdominal aortic aneurysm.  Br J Surg. 1994;  81 935
    CrossrefPubMedGoogle Scholar
  • 84 May J, White G H, Ly C N. et al . Endoluminal repair of abdominal aortic aneurysm prevents enlargement of the proximal neck: a 9-year life-table and 5-year longitudinal study.  J Vasc Surg. 2003;  37 86-90
    CrossrefPubMedGoogle Scholar
  • 85 Mitchell M B, Rutherford R B, Krupski W C. Infrarenal aortic aneurysms. In: Rutherford RB (ed) Vascular surgery. Philadelphia; WB Saunders 1995: 1032
    PubMedGoogle Scholar
  • 86 Miyake T, Morishita R. Pharmacological treatment of abdominal aortic aneurysm.  Cardiovasc Res. 2009;  83 436-443
    CrossrefPubMedGoogle Scholar
  • 87 Muehling B. et al . Prospective randomized controlled trial to evaluate „fast-track” elective open infrarenal aneurysm repair.  Langenbecks Arch Surg. 2008;  393 281-287
    CrossrefPubMedGoogle Scholar
  • 88 Multicentre aneurysm screening study (MASS) . Cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial.  BMJ. 2002;  325 1135
    CrossrefPubMedGoogle Scholar
  • 89 Newman A B, Arnodl A M, Burke G L. et al . Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography: The Cardiovascular Health Study.  Ann Intern Med. 2001;  134 182
    PubMedGoogle Scholar
  • 90 Ng S F. et al . A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia.  Anesth Analg. 2003;  96 171-176
    CrossrefPubMedGoogle Scholar
  • 91 Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.The UK Small AneurysmTrial Participants.  Lancet. 1998;  352 1649-1655
    CrossrefPubMedGoogle Scholar
  • 92 Norman P E, Jamrozik K, Lawrence-Brown M M. et al . Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm.  BMJ. 2004;  329 1259
    CrossrefPubMedGoogle Scholar
  • 93 Ouriel K, Green R M, Donayre C. et al . An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture.  J Vasc Surg. 1992;  15 12-18
    CrossrefPubMedGoogle Scholar
  • 94 Ouriel K, Srivastava S D, Sarac T P. et al . Disparate outcome after endovascular treatment of small versus large abdominal aortic aneurysm.  J Vasc Surg. 2003;  37 1206
    CrossrefPubMedGoogle Scholar
  • 95 Paravastu S CV, Ghosh J, Murray D. et al . A systematic review of open versus endovascular repair of inflammatory abdominal aortic aneurysms.  Eur J Vasc Endovasc Surg. 2009;  38 291-297
    CrossrefPubMedGoogle Scholar
  • 96 Pennell R C, Hollier L H, Lie J T. et al . Inflammatory abdominal aortic aneurysms: a thirty-year review.  J Vasc Surg. 1995;  2 859
    CrossrefPubMedGoogle Scholar
  • 97 Peppelenbosch N, Buth J, Harris P L. et al . Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR.  J Vasc Surg. 2004;  39 288
    CrossrefPubMedGoogle Scholar
  • 98 Perry R J, Martin M J, Eckert M J. et al . Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair.  J Vasc Surg. 2008;  48 272-277
    CrossrefPubMedGoogle Scholar
  • 99 Powell J T, Greenhalgh R M. Clinical practice. Small abdominal aortic aneurysms.  N Engl J Med. 2003;  348 1895-1901
    CrossrefPubMedGoogle Scholar
  • 100 Powell J T, Brown L C, Forbes J F. et al . Final 12-year follow-up of surgery versus surveillance in the UK Small AneurysmTrial.  Br J Surg. 2007;  94 702-708
    CrossrefPubMedGoogle Scholar
  • 101 van Prehn J, Schlösser F JV, Muhs B E. et al . Oversizing of aortic stent grafts for abdominal aneurysm repair: A systematic review of the benefits and risks.  Eur J Vasc Endovasc Surg. 2009;  38 42-53
    CrossrefPubMedGoogle Scholar
  • 102 Prinssen M, Verhoeven E L, Buth J. et al . A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.  N Engl J Med. 2004;  351 1607
    CrossrefPubMedGoogle Scholar
  • 103 Propanolol Aneurysm Trial Investigators . Propranolol for small abdominal aortic aneurysms: results of a randomized trial.  J Vasc Surg. 2002;  35 72-79
    CrossrefPubMedGoogle Scholar
  • 104 Rasmussen T E, Hallett Jr J W. Inflammatory aortic aneurysms. A clinical review with new perspectives in pathogenesis.  Ann Surg. 1997;  225 155
    CrossrefPubMedGoogle Scholar
  • 105 Rayt H S, Bown M J, Lambert K V. et al . Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair.  Cardiovasc Intervent Radiol. 2008;  31 728-734
    CrossrefPubMedGoogle Scholar
  • 106 Reed D, Reed C, Stemmermann G. et al . Are aortic aneurysms caused by atherosclerosis?.  Circulation. 1992;  85 205
    CrossrefPubMedGoogle Scholar
  • 107 Rembold C M. Number needed to screen: development of a statistic for disease screening.  BMJ. 1998;  317 307-312
    CrossrefPubMedGoogle Scholar
  • 108 Resch T, Malina M, Lindblad B, Ivancev K. The impact of stent-graft development on outcome of AAA repair–a 7-year experience.  Eur J Vasc Endovasc Surg. 2001;  22 57-61
    CrossrefPubMedGoogle Scholar
  • 109 Rozenblit A, Rozenblit G, Meddineni S. The role of helical CT-angiography in endovascular grafting procedures. In: Parodi JC, Veith F, Marin M (eds) Endovascular Grafting Techniques. Philadelphia; Williams and Wilkins 1999: 15
    PubMedGoogle Scholar
  • 110 Sakalihasan N, Limet R, Defawe O D. Abdominal aortic aneurysm.  Lancet. 2005;  365 1577-1589
    CrossrefPubMedGoogle Scholar
  • 111 Salo J A, Soisalon-Soininen S, Bondestam S. et al . Familial occurrence of abdominal aortic aneurysm.  Ann Intern Med. 1999;  130 637
    PubMedGoogle Scholar
  • 112 Sandford R M, Bown M J, London N J, Sayers R D. The genetic basis of abdominal aortic aneurysms: a review.  Eur J Vasc Endovasc Surg. 2007;  33 381-390
    CrossrefPubMedGoogle Scholar
  • 113 Schermerhorn M L, O’Malley A J, Jhaveri A. et al . Endovascular vs. open repair of abdominal aortic aneurysms in the medicare population.  N Engl J Med. 2008;  358 464
    CrossrefPubMedGoogle Scholar
  • 114 Schlosser F J, Gusberg R J, Dardik A. et al . Aneurysm rupture after EVAR: can the ultimate failure be predicted?.  Eur JVasc Endovasc Surg. 2009;  37 15-22
    CrossrefPubMedGoogle Scholar
  • 115 Schwenk W. et al . Fast-track rehabilitation after rectal cancer resection.  Int J Colorectal Dis. 2006;  21 547-553
    CrossrefPubMedGoogle Scholar
  • 116 Scott R A, Bridgewater S G, Ashton H A. Randomized clinical trial of screening for abdominal aortic aneurysm in women.  Br J Surg. 2002;  89 283-285
    CrossrefPubMedGoogle Scholar
  • 117 Scott R A, Wilson N M, Ashton H A, Kay D N. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study.  Br J Surg. 1995;  82 1066-1070
    CrossrefPubMedGoogle Scholar
  • 118 Shibamura H, Olson J M, van Vlijmen-Van Keulen C. et al . Genome scan for familial abdominal aortic aneurysm using sex and family history as covariates suggests genetic heterogeneity and identifies linkage to chromosome 19q13.  Circulation. 2004;  109 2103
    CrossrefPubMedGoogle Scholar
  • 119 Simon G, Nordgren D, Connelly S. et al . Screening for abdominal aortic aneurysms in a hypertensive patient population.  Arch Intern Med. 1996;  156 2081
    CrossrefPubMedGoogle Scholar
  • 120 Singh K, Bonaa K H, Jacobsen B K. et al . Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: TheTromso Study.  Am J Epidemiol. 2001;  154 236-244
    CrossrefPubMedGoogle Scholar
  • 121 Sprouse 2nd  L R, Meier 3rd  G H, Lesar C J. et al . Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: Is there a difference?.  J Vasc Surg. 2003;  38 466
    CrossrefPubMedGoogle Scholar
  • 122 Sukhija R, Aronow W S, Sandhu R. et al . Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins.  Am J Cardiol. 2006;  97 279-280
    CrossrefPubMedGoogle Scholar
  • 123 Teufelsbauer H, Prusa A M, Wolff K. et al . Endovascular stent grafting versus open surgical operation in patients with infrarenal aortic aneurysms: a propensity score-adjusted analysis.  Circulation. 2002;  106 782-787
    CrossrefPubMedGoogle Scholar
  • 124 Thurmond A S, Semler H J. Abdominal aortic aneurysm: incidence in a population at risk.  J Cardiovasc Surg. 1986;  27 457-460
    PubMedGoogle Scholar
  • 125 Tilson M D. Aortic aneurysms and atherosclerosis.  Circulation. 1992;  85 378
    PubMedGoogle Scholar
  • 126 UK National Screening Committee ASWG .Standard operating procedures for an abdominal aortic aneurysm (AAA) screening programme. Draft version 7. RefType: Report. 2002
    PubMedGoogle Scholar
  • 127 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 1649-1655
    CrossrefPubMedGoogle Scholar
  • 128 UK Small Aneurysm Trial Participants . Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med. 2002;  346 1445-1452
    CrossrefPubMedGoogle Scholar
  • 129 Urbonavicius S, Urbonaviciene S, Honore‘ B. et al . Potential circulating biomarkers for abdominal aortic aneurysm expansionand rupture – a systematic review.  Eur J Vasc Endovasc Surg. 2008;  36 273-280
    CrossrefPubMedGoogle Scholar
  • 130 Vainas T, Lubbers T, Stassen F R. et al . Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue.  Circulation. 2003;  107 1103
    CrossrefPubMedGoogle Scholar
  • 131 Vardulaki K A, Prevost T C, Walker N M. et al . Incidence among men of asymptomatic abdominal aortic aneurysms: estimates from 500 screen detected cases.  J Med Screen. 1999;  6 50-54
    PubMedGoogle Scholar
  • 132 Verloes A, Sakalihasan N, Koulischer L, Limet R. Aneurysms of the abdominal aorta: familial and genetic aspects in three hundred thirteen pedigrees.  J Vasc Surg. 1995;  21 646-655
    CrossrefPubMedGoogle Scholar
  • 133 Volodos N L, Karpovich I P, Troyan V I. 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. 1991;  33 93-95
    CrossrefPubMedGoogle Scholar
  • 134 White G H, Yu W, May J. Endoleak –aproposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft.  J Endovasc Surg. 1996;  3 124-125
    PubMedGoogle Scholar
  • 135 Wilson W R, Anderton M, Schwalbe E C. et al . Matrix metalloproteinase-8 and -9 are increased at the site of abdominal aortic aneurysm rupture.  Circulation. 2006;  113 438-445
    CrossrefPubMedGoogle Scholar
  • 136 Yusuf S W, Hopkinson B R. The Nottingham experience with endovascular repair of abdominal aortic aneurysms; In: Parodi JC, Veith F, Marin M (eds) Endovascular Grafting Techniques. Philadelphia; Williams & Wilkins 1999: 73
    PubMedGoogle Scholar

Univ.-Prof. Dr. Eike Sebastian Debus

Klinik und Poliklinik für Gefäßmedizin
Universitäres Herzzentrum
Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52
20246 Hamburg

Email: debus@uke.de

      >