Download PDF
Dtsch Med Wochenschr 2016; 141(14): 1030-1034
DOI: 10.1055/s-0041-108998
Fachwissen
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Ultraschall-Screening auf abdominelle Aortenaneurysmen

Eine sinnvolle Maßnahme zur Vermeidung der plötzlichen RupturUltrasound screening for abdominal aortic aneurysms – a rational measure to prevent sudden rupture
Giovanni Torsello
1   Klinik für Vaskuläre und Endovaskuläre Chirurgie, Universitätsklinikum Münster
,
Eike Sebastian Debus
2   Universitäres Herzzentrum GmbH, Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf
,
Thomas Schmitz-Rixen
3   Klinik für Gefäß- und Endovascular-Chirurgie, Klinikum der Goethe-Universität Frankfurt am Main
,
Reinhart Thomas Grundmann
4   Deutsches Institut für Gefäßmedizinische Gesundheitsforschung (DIGG) der DGG, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
12 July 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Das rupturierte abdominelle Aortenaneurysma (AAA) hat auch heute noch eine hohe Krankenhaussterblichkeit von ca. 50 % (Interventionen und nicht-korrigierende Behandlung zusammengefasst). Mit einer einfachen, nicht-invasiven und preiswerten Maßnahme wie dem Ultraschall-Screening lassen sich rupturgefährdete Aneurysmen rechtzeitig erkennen und dann prophylaktisch versorgen, der Blutungsschock kann so vermieden werden. In den Screening-Programmen Englands und Schwedens wird aktuell eine AAA-Prävalenz bei den gescreenten 65-jährigen Männern von 1,5 % beschrieben. Damit ist das Screening bei dieser Zielgruppe mit einer absoluten Risikoreduktion für einen Aneurysma-bezogenen Tod von 15,1 pro 10.000 zum Screening eingeladene Männer und Kosten von £7370 pro gewonnenes Qualitätsadjustiertes Lebensjahr (QALY) hoch kosteneffektiv. Ein flächendeckendes AAA-Screening setzt ein Screening-Programm mit definierten Anforderungen an die Qualität der Ultraschall-Untersuchung und die der operativen Versorgung der durch Screening entdeckten großen AAA voraus. Die Konzentration dieser Eingriffe in Zentren, die sich zu einer Qualitätsdokumentation in Registern verpflichten, ist zu fordern. Patienten mit kleinen, nicht-interventionsbedürftigen Aneurysmen müssen langfristig überwacht und ihre Daten ebenfalls registriert werden

Abstract

The ruptured abdominal aortic aneurysm (AAA) has still a high hospital mortality rate of about 50 % (intervention and non-corrective treatment combined). With an easy non-invasive and inexpensive measure such as the ultrasound screening rupture threatened aneurysms can be recognized in time and then treated prophylactically, hemorrhagic shock can be avoided. Screening programs in England and Sweden currently describe an AAA prevalence of 1.5 % among screened 65-year-old males. With an absolute risk reduction for aneurysm-related death of 15.1 per 10,000 men invited for screening and a cost of £ 7,370 per quality-adjusted life year (QALY), screening for this target group is highly cost-effective. Comprehensive AAA screening requires defined criteria for the quality of the aortic ultrasound examination and for the surgical treatment of detected large AAA. These interventions should be concentrated in centers obligated to quality registry documentation. Patients with smaller AAA, requiring no repair, should be included in a surveillance program, also with registry of their long-term data.

Schlüsselwörter

abdominelles Aortenaneurysma - Screening - Qualitätskriterien - Rupturrisiko - Population

Keywords

abdominal aortic aneurysm - screening - quality criteria - rupture risk - target population
 

  • Literatur

  • 1 Karthikesalingam A, Holt PJ, Vidal-Diez A, Ozdemir BA, Poloniecki JD, Hinchliffe RJ, Thompson MM. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet 2014; 383 (9921) 963-969
    CrossrefPubMedGoogle Scholar
  • 2 IQWIG Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. Ultraschall-Screening auf Bauchaortenaneurysmen. Abschlussbericht. Stand 02.04.2015
    PubMed
  • 3 Ferket BS, Grootenboer N, Colkesen EB et al. Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg 2012; 55: 1296-1304
    CrossrefPubMedGoogle Scholar
  • 4 Erbel R, Aboyans V, Boileau C et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2873-2926
    CrossrefPubMedGoogle Scholar
  • 5 Lederle FA, Johnson GR, Wilson SE et al. The aneurysm detection and management study screening program: validation cohort and results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med 2000; 160: 1425-1430
    CrossrefPubMedGoogle Scholar
  • 6 Jahangir E, Lipworth L, Edwards TL et al. Smoking, sex, risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study. J Epidemiol Community Health 2015; 69: 481-488
    CrossrefPubMedGoogle Scholar
  • 7 Stackelberg O, Björck M, Larsson SC, Orsini N, Wolk A. Sex differences in the association between smoking and abdominal aortic aneurysm. Br J Surg 2014; 101: 1230-1237
    CrossrefPubMedGoogle Scholar
  • 8 Svensjö S, Björck M, Wanhainen A. Current prevalence of abdominal aortic aneurysm in 70-year-old women. Br J Surg 2013; 100: 367-372
    CrossrefPubMedGoogle Scholar
  • 9 Svensjö S, Björck M, Wanhainen A. Update on screening for abdominal aortic aneurysm: a topical review. Eur J Vasc Endovasc Surg 2014; 48: 659-667
    CrossrefPubMedGoogle Scholar
  • 10 Lo RC, Lu B, Fokkema MT et al.; Vascular Study Group of New England. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. J Vasc Surg 2014; 59: 1209-1216
    CrossrefPubMedGoogle Scholar
  • 11 Larsson E, Granath F, Swedenborg J, Hultgren R. A population-based case-control study of the familial risk of abdominal aortic aneurysm. J Vasc Surg 2009; 49: 47-50 discussion 51
    CrossrefPubMedGoogle Scholar
  • 12 Sakalihasan N, Defraigne JO, Kerstenne MA et al. Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liège AAA Family Study. Ann Vasc Surg 2014; 28: 787-797
    CrossrefPubMedGoogle Scholar
  • 13 NHS. Public health functions to be exercised by NHS England. Service specification No. 23. NHS Abdominal Aortic Aneurysm Screening Programme. November 2013 www.gov.uk/government/uploads/system/uploads/attachment_data/file/256500/23_nhs_abdominal_aortic_aneurysm.pdf Letzter Zugriff: 23. 5. 2016
    PubMed
  • 14 Davis M, Harris M, Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 2013; 57: 1440-1445
    CrossrefPubMedGoogle Scholar
  • 15 Earnshaw J. The National Health Service Abdominal Aortic Aneurysm Screening Programme in England. Implementation and optimization. Gefässchirurgie 2014; 19: 528-533
    PubMedGoogle Scholar
  • 16 Svensjö S, Björck M Wanhainen. Editor‘s choice: five-year outcomes in men screened for abdominal aortic aneurysm at 65 years of age: a population-based cohort study. Eur J Vasc Endovasc Surg 2014; 47: 37-44
    CrossrefPubMedGoogle Scholar
  • 17 Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med 2012; 172: 1456-1462
    CrossrefPubMedGoogle Scholar
  • 18 Hye RJ, Smith AE, Wong GH, Vansomphone SS, Scott RD, Kanter MH. Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program. J Vasc Surg 2014; 59: 1535-1542
    CrossrefPubMedGoogle Scholar
  • 19 Hager J, Lanne T, Carlsson P, Lundgren F. No benefit of screening for abdominal aortic aneurysm among 70- instead of 65-year-old men. Int Angiol 2014; 33: 474-479
    PubMedGoogle Scholar
  • 20 Linne A, Leander K, Lindström D, Törnberg S, Hultgren R. Reasons for non-participation in population-based abdominal aortic aneurysm screening. Br J Surg 2014; 101: 481-487
    CrossrefPubMedGoogle Scholar
  • 21 Li X, Zhao G, Zhang J, Duan Z, Xin S. Prevalence and trends of the abdominal aortic aneurysms epidemic in general population--a meta-analysis. PLoS One 2013; 8: e81260
    CrossrefPubMedGoogle Scholar
  • 22 Anjum A, von Allmen R, Greenhalgh R, Powell JT. Explaining the decrease in mortality from abdominal aortic aneurysm rupture. Br J Surg 2012; 99: 637-645
    CrossrefPubMedGoogle Scholar
  • 23 Glover MJ, Kim LG, Sweeting MJ, Thompson SG, Buxton MJ. Cost-effectiveness of the National Health Service Abdominal Aortic Aneurysm Screening Programme in England. Br J Surg 2014; 101: 976-982
    CrossrefPubMedGoogle Scholar
  • 24 Hager J, Länne T, Carlsson P, Lundgren F. Lower prevalence than expected when screening 70-year-old men for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2013; 46: 453-459
    CrossrefPubMedGoogle Scholar
  • 25 Svensjö S, Mani K, Björck M, Lundkvist J, Wanhainen A. Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management. Eur J Vasc Endovasc Surg 2014; 47: 357-365
    CrossrefPubMedGoogle Scholar
  • 26 Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013; CD001877
    PubMedGoogle Scholar
  • 27 Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA 2014; 311: 1327-1335
    CrossrefPubMedGoogle Scholar
  • 28 Olchanski N, Winn A, Cohen JT, Neumann PJ. Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit?. J Gen Intern Med 2014; 29: 1155-1161
    CrossrefPubMedGoogle Scholar
  • 29 RESCAN Collaborators, Bown MJ, Sweeting MJ, Brown LC, Powell JT, Thompson SG. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis. JAMA 2013; 309: 806-813
    CrossrefPubMedGoogle Scholar
  • 30 Powell JT, Thompson SG. Should the frequency of surveillance for small abdominal aortic aneurysms be reduced?. Eur J Vasc Endovasc Surg 2013; 46: 171-172
    CrossrefPubMedGoogle Scholar
  • 31 Wild JB, Stather PW, Biancari F et al. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation. Eur J Vasc Endovasc Surg 2013; 45: 128-134
    CrossrefPubMedGoogle Scholar
  • 32 Heidemann F, Meier U, Kölbel T, Atlihan G, Debus ES. Wie ist die Umsetzung eines AAA-Screening-Programms in Deutschland möglich?. Gefässchirurgie 2014; 19: 564-567
    CrossrefPubMedGoogle Scholar
  • 33 Hartshorne TC, McCollum CN, Earnshaw JJ, Morris J, Nasim A. Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 2011; 42: 195-199
    CrossrefPubMedGoogle Scholar
  • 34 Meecham L, Evans R, Buxton P et al. Abdominal aortic aneurysm diameters: a study on the discrepancy between inner-to-inner and outer-to-outer measurements. Eur J Vasc Endovasc Surg 2015; 49: 28-32
    CrossrefPubMedGoogle Scholar
  • 35 Svensjö S, Björck M, Gürtelschmid M et al. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation 2011; 124: 1118-1123
    CrossrefPubMedGoogle Scholar
  • 36 Schäberle W, Leyerer L, Schierling W, Pfister K. Ultraschalldiagnostik der abdominellen Aorta. Gefässchirurgie 2014; 19: 558-563
    CrossrefPubMedGoogle Scholar
  • 37 Chiu KW, Ling L, Tripathi V, Ahmed M, Shrivastava V. Ultrasound measurement for abdominal aortic aneurysm screening: a direct comparison of the three leading methods. Eur J Vasc Endovasc Surg 2014; 47: 367-373
    CrossrefPubMedGoogle Scholar
  • 38 Debus ES, Nüllen H, Torsello G et al. Zur Behandlung des abdominellen Aortenaneurysmas in Deutschland: Qualitätssicherungsdaten 2013. Gefässchirurgie 2014; 19: 412-421
    CrossrefPubMedGoogle Scholar
  • 39 Linné A, Smidfelt K, Langenskiöld M et al. Low post-operative mortality after surgery on patients with screening-detected abdominal aortic aneurysms: A Swedvasc Registry Study. Eur J Vasc Endovasc Surg 2014; 48: 649-656
    CrossrefPubMedGoogle Scholar