Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

Debus, Eike Sebastian; Heidemann, Franziska; Gross-Fengels, W.; Mahlmann, Adrian; Muhl, Elke; Pfister, Karin; Roth, S.; Stroszczynski, Christian; Walther, Andreas; Weiss, Norbert; Wilhelmi, Mathias; Grundmann, Reinhart T.

doi:10.1007/s00772-018-0465-x

Cited by 10 publications

(12 citation statements)

References 117 publications

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“…These findings indicate that in the absence of a valid German S3 guideline for treatment of AAA, clinical practice varied greatly in Germany during the observation period, despite the valid European Guideline [24]. It will be interesting to see whether treatment methods are harmonizing since publication of the German guideline in 2018 [2]. However, due to the administrative character of the dataset, the underlying indications for EVAR or OAR cannot be fully identified and comprehended in the light of applicable guidelines and practices.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent rupture, either the affected vessel segment can be replaced with a prosthesis in an open approach (open aortic repair, OAR) or treatment may be endovascular, by implanting a stent graft (endovascular aortic repair, EVAR). According to current guidelines, treatment is indicated when an AAA exceeds 55 mm in diameter, but might be performed earlier in some cases [2,3]. In Germany, however, many cases are treated below this threshold [4].…”

Section: Introductionmentioning

confidence: 99%

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Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Trenner

Salvermoser

Reutersberg

et al. 2020

Vasa

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Summary: Background: Abdominal aortic aneurysms (AAA) can be treated by either open surgery (OAR) or endovascular aortic repair (EVAR). The aim of this study was to analyze regional variations in application of (EVAR) and in-hospital mortality after intact AAA (iAAA) repair. Methods: Using data provided by the German Federal Statistical Office, a nationwide analysis for 2012 to 2014 was conducted. Patients with a diagnosis of iAAA (I71.4) and corresponding procedure codes for OAR (5-384.5/7) or EVAR (5-38a.1) were included. Odds ratios (ORs) for use of EVAR (proportion of EVAR among total EVAR + OAR cases) and mortality were calculated for all regions in Germany. ORs for EVAR use were adjusted for age, sex, and risk (Elixhauser score). ORs for mortality were additionally adjusted for type of procedure (OAR/EVAR). Results: Finally, 31,757 procedures for iAAA were included. Median age of all patients was 73 years (interquartile range 67–78 years) and 87.1 % were male. The mean proportion of EVAR procedures was 72.6 %; however, the application of EVAR for repair of iAAA varied widely depending on region. The lowest unadjusted regional rate of EVAR use was 48.8 %, while the highest was 92.5 %. After adjustment, the lowest regional OR for EVAR use (compared to the nationwide mean) was 0.23 (95 % confidence interval [0.15–0.36]), the highest 5.93 [1.79–19.65]. Overall in-hospital mortality was 2.9 % (OAR 6.2 %; EVAR 1.7 %). The adjusted regional OR for mortality ranged from 0.31 [0.07–1.42] to 4.98 [2.08–11.93]. Conclusions: This study reveals variations in use of EVAR and in-hospital mortality for iAAA treatment in Germany. This may imply that selection of treatment might not only be influenced by patient characteristics, but also by regional location. These results need to be taken into account when discussing centralization of AAA treatment in Germany.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Trenner

Salvermoser

Reutersberg

et al. 2020

Vasa

View full text Add to dashboard Cite

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“…However, precise rupture prediction for the individual AAA remains a challenge, and is currently based on epidemiological and morphological data. 11,13 In previous studies, WMIs, obtained by mechanical modelling and statistical analysis based on 4D ultrasound measurements, have been proposed as mechanical biomarkers for the pathophysiological state of the individual AAA wall. In the current study, WMIs are shown to be capable of characterising the kinematic differences between AAA sac and neck non-invasively in vivo.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Abdominal Aortic Aneurysm Sac and Neck Wall Motion with 4D Ultrasound Imaging

Derwich

Wittek

Hegner

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSAfter developing the wall motion indices (WMIs), based on statistical analysis of 4D ultrasound strain imaging, previous studies have demonstrated the kinematic differences of aortic wall deformation according to age and cardiovascular pathology. In the current study, the pathological wall motion in the abdominal aortic aneurysm (AAA) is described for the first time. The specific kinematic properties of aneurysm neck and degenerated aneurysm bulge are characterised using WMIs and the regions with higher heterogeneity are identified. This is a promising step on the way to making additional individual patient information available for the evaluation of AAA stability.Objective: The rupture of abdominal aortic aneurysms (AAAs) is associated with high mortality despite surgical developments. The determination of aneurysm diameter allows for follow up of aneurysm growth but fails in precisely predicting aneurysm rupture. In this study, time resolved three dimensional ultrasound (4D ultrasound) based wall motion indices (WMIs) are investigated to see if they are capable of distinguishing between uneven affected regions of the aneurysm wall. Methods: In a prospective study, 56 patients with an AAA were examined using 4D ultrasound. Local longitudinal, circumferential, and shear strains were computed using custom methods. The deformation of the neck and sac of each aneurysm was characterised by statistical indices of the obtained distributions of local wall strains (WMIs): mean and peak strain, heterogeneity index, and local strain ratio. The locations of regions with highest local peak strain were determined. Results: Compared with the aneurysm neck, the sac is characterised by low mean strain, but highly heterogeneous deformation, described by high local strain ratio and heterogeneity index. Differences were highly significant (p < .001) for all strain components. The regions with the highest circumferential peak strain were found more often in the posterior part of the aneurysm neck (p < .050) and sac (p < .001) regions, compared with other wall regions. No statistically significant correlation was found between the WMIs and maximum AAA diameter, except for longitudinal mean strain, which decreased with the increasing diameter (rho ¼ À.42, p < .010). Conclusion: Characterisation of wall kinematics by 4D ultrasound based WMIs provides a new and independent criterion for the distinction of diseased tissue in the AAA sac and the less affected neck region. This is a promising step towards the establishment of new biomarkers to differentiate between the mechanical instability of the AAA and rupture risk.

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“…Although open surgical repair is supported as the gold standard for mycotic aortic aneurysms in current aortic aneurysm guidelines, endovascular repair is recommended as an alternative 23 , 24 owing to early survival benefit up to 4 years postoperatively. 25 We consider EG impregnation with RIF in such cases as legitimate in addition to systemic antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of antiseptic impregnation of aortic endografts with rifampicin compared to silver against in vitro contamination with four bacteria that frequently cause vascular graft infections

Honig

Seeger

Rohde

et al. 2020

JVS-Vascular Science

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Objective This in vitro study investigates the antimicrobial efficacy of impregnation of commercially available aortic endografts (EG) with rifampicin (RIF) and nanocolloidal silver. Methods Endografts were flushed with 50 mL of RIF 600 mg, 70 mL of a silver-based aqueous solution (AG), or 50 mL of phosphate-buffered saline (PBS) over 15 minutes. Endografts were then retrieved from the sheath and cut in 1 × 1 cm sized graft units (n = 80 of each impregnation), which were then incubated for 1 hour separately with inoculates containing 10 6 or 10 3 bacteria per milliliter (bact/mL) of each of the following bacteria: Staphylococcus epidermidis, Escherichia coli, multisensitive Staphylococcus aureus , and Pseudomonas aeruginosa . After sonication of the graft units, bacterial counts were measured by plating out twice the sonication solution on Mueller-Hinton plates. Results RIF showed a statistically significant decrease of colony forming units per milliliter for all four bacterial strains in both concentrations compared with PBS and AG, except for 10 3 bact/mL of E coli . AG showed a significant decrease of colony forming units per milliliter compared with PBS only for 10 6 bact/mL of E coli and was statistically significantly inferior to RIF for all four bacterial strains in both concentrations with the exception of E coli at a concentration of 10 3 bact/mL. Conclusions This in vitro study demonstrated infectivity resistance of aortic EG after flushing with RIF. Moreover, the feasibility of flushing aortic EG with a new silver-based agent could be demonstrated, but without statistically significant antimicrobial efficacy compared with native EG.

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Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

Cited by 10 publications

References 117 publications

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Comparison of Abdominal Aortic Aneurysm Sac and Neck Wall Motion with 4D Ultrasound Imaging

Efficacy of antiseptic impregnation of aortic endografts with rifampicin compared to silver against in vitro contamination with four bacteria that frequently cause vascular graft infections

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