Screening und Surveillance des abdominellen Aortenaneurysmas

Zusammenfassung

Ein Screening der Population für das abdominelle infrarenale Bauchaortenaneurysma ist nur grenzwertig kosteneffektiv. Ein Screening der Subpopulation von männlichen Rauchern zwischen 60 und 75 Jahren und von Männern und rauchenden Frauen mit positiver Familienanamnese oder vaskulären Krankheiten anderer Lokalisation und Ursache ist jedoch kosteneffektiv. Es kann die steigende Mortalität halbieren. Die Indikation zum Handeln ist bei Männern ab einem Aneurysmadurchmesser von 5,5 cm gegeben, bei Frauen ist dieser Grenzwert noch zu bestimmen, dürfte aber bei 4,5 bis 5 cm liegen.

Die Surveillance noch nicht für eine Aneurysmaausschaltung in Frage kommender Patienten darf nicht nur den Aneurymadurchmesser berücksichtigen, sondern sollte auch bei Überschreiten einer jährlichen Wachstumsrate von 0,5 cm zur Behandlung führen.

Summary

A screening program for infrarenal abdominal aortic aneurysm (AAA) has limited cost-effectiveness. Yet, screening of the subpopulation of smoking men aged 60-75 years, or men and smoking women with a family history of vascular diseases or other cardio-vascular co-morbidity is cost-effective and has been demonstrated. It is suited to halve the increasing mortality of AAA. Elective repair of AAA is justified at diameters larger than 5.5 cm for men, but uncertain for women. However, aortic diameters between 4.5 and 5 cm in women probably necessitate an invasive approach.

Surveillance of patients who still not meet these criteria should not only include the absolute diameter of the aneurysm, but direct individuals with aneurysms at an annual expansion rate of more than 0,5 cm to elective repair.

Schlüsselwörter

Aneurysma - Bauchaortenaneurysma

Keywords

Aneurysm - abdominal aortic aneurysm

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