Ultraschall-Screening auf abdominelle Aortenaneurysmen

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

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