Therapie des abdominellen aortenaneurysmas

Abdominal aortic repair (AAr) may be performed during an elective or emergency operation through an open incision or endovascular procedure. Emergency treatment of highly symptomatic or ruptured aneurysms has a higher 30-day mortality compared to an elective operation. Early detection of asymptomatic AAAs can be achieved by screening high risk patients leading to higher rates of elective abdominal aortic repair with lower rates of mortality. Although there are many randomized trials investigating the possible benefits of open or endovascular aortic repair (EVAR) there is still no general recommendation on which technique should be preferred. In Germany more than 50% of AAAr is performed endovascularly through a minimal-invasive technique. However an individualized consideration and assessment of factors influencing outcome and mortality is essential for deciding between an open or endovascular procedure. Continuous enhancement of materials and operative techniques reduce hospital length of stay as well as mortality following EVAR. Currently however EVAR provides a therapy option for high risk patients not suitable for open AAr. In the future continuous improvement in operational techniques will eventually lead to a similar outcome for both procedures. Therefore decision making in regard to open or endovascular repair will also be influenced by economical aspects.