Please use this identifier to cite or link to this item: doi:10.22028/D291-45540
Title: Offener vs. interventioneller Aortenrepair bei Bauchaortenaneurysma: Analyse und Vergleich zweier Verfahren in einem zertifizierten und interdisziplinären Gefäßzentrum
Author(s): Summa, Annalena
Language: German
Year of Publication: 2025
Place of publication: Homburg/Saar
DDC notations: 610 Medicine and health
Publikation type: Dissertation
Abstract: Hintergrund: Abdominelle Bauchaortenaneurysmen können heutzutage entweder offen-chirurgisch mit einer Gefäßprothese oder endovaskulär mit einem Stentgraft behandelt werden. In den letzten Jahren hat sich die endovaskuläre Therapie dabei als wichtige Säule neben der operativen Variante etabliert. Durch die Entwicklung neuer Devices und speziell angefertigter endovaskulärer Stentgrafts hat sich auch ihr Einsatzgebiet erheblich erweitert. Diese retrospektive Studie wurde durchgeführt, um einen Vergleich der beiden Verfahren bezüglich ihres Outcomes am zertifizierten Gefäßzentrum der Universitätsklinik in Homburg zu erlangen. Methoden: Für die Datenerhebung wurden alle Patienten mit einem abdominellen Aortenaneurysma berücksichtigt, die zwischen dem 01.01.2014 und dem 30.04.2019 im Gefäßzentrum der Universitätsklinik in Homburg durch eine der Therapieformen behandelt wurden. Die Gruppeneinteilung war dabei nicht randomisiert. In jeder Gruppe erfolgte eine weitere Differenzierung zwischen Patienten mit einem rupturierten Aneurysma und solchen mit einem nicht-rupturierten Aneurysma. Für den direkten Vergleich wurden demografische, aneurysmabezogene, prozedurale und klinische Daten untersucht. Zudem wurde die Länge des gesamtstationären Aufenthalts und des Intensivaufenthalts, die Komplikationsinzidenz und das Komplikationsspektrum sowie die Inzidenz von Reinterventionen/Reoperationen und die primäre Krankenhaussterblichkeit miteinander verglichen. Ergebnisse: Von insgesamt 185 Patienten wurden 115 endovaskulär therapiert. Die restlichen 70 Patienten wurden durch eine offen-chirurgische Therapie behandelt. Im Durchschnitt verbrachten die operativ therapierten Patienten 3 Tage länger auf der Intensivstation (p<0,001) und wurden durchschnittlich 4 Tage später aus dem Krankenhaus entlassen (p<0,001). Prozedurassoziierte Komplikationen und Re-Eingriffe traten während der Primärhospitalisation jeweils häufiger in der endovaskulären Gruppe auf (Komplikationen: EVAR: 75,7%; OP: 34,3%; p<0,001 // Re-Eingriffe: EVAR: 33,9%; OP: 27,1%; p=0,336). Die häufigste endovaskuläre Komplikation, die dabei erfasst werden konnte, war das Auftreten eines Endoleaks (68/115 Patienten; 59,1%) (über 85 Prozent Grad I der Clavien-Dindo-Klassifikation). Operativ kam es am häufigsten zu Darmischämien (11/70 Patienten; 15,7%) und abdominellen Kompartmentsyndromen (6/70 Patienten; 8,6%) (Grad IIIB bis Grad V der Clavien-Dindo-Klassifikation). Auch nach der Entlassung kamen prozedurassoziierte Komplikationen und Re-Eingriffe häufiger in der endovaskulären Gruppe vor (Komplikationen: EVAR: 19,1%; OP: 11,4%; p=0,218 // Re-Eingriffe: EVAR: 16,5%; OP: 10%; p=0,216). Die führende endvaskuläre Komplikation war abermals das Auftreten eines Endoleaks (8/115 Patienten; 7,0%) (vorallem Grad IIIA der Clavien-Dindo-Klassifikation). Im Langzeitverlauf traten jedoch auch schwerwiegendere Komplikationen wie sekundäre Rupturen und Stentgraftinfektionen auf (Grad IIIB bis Grad IVB der Clavien-Dindo-Klassifikation). In der operativen Gruppe kam es nach der Entlassung am häufigsten zu Narbenhernien (6/70 Patienten; 8,6%) (Grad IIIB der Clavien-Dindo-Klassifikation). Bezüglich der Mortalität zeigte sich während der Primärhospitalisation eine signifikant niedrigere Mortalitätsrate in der endovaskulären Gruppe (EVAR: 3,5%; OP: 20%; p=0,001). Zu beachten ist hierbei allerdings eine ungleiche Gruppenverteilung rupturierter Aneurysmen, die mit einem erhöhten Mortalitätsrisiko einhergehen. Die Rate rupturierter Aneurysmen betrug in der operativen Gruppe 27,1 Prozent und in der endovaskulären Gruppe 7,8 Prozent. Schlussfolgerung: Die EVAR-Gruppe wies eine signifikant niedrigere Krankenhaussterblichkeit und einen signifikant kürzeren Krankenhausaufenthalt auf. Allerdings verzeichnete sie auch eine deutlich niedrigere Rate rupturierter Aneurysmen. Re-Eingriffe und prozedurassoziierte Komplikationen traten häufiger in der endovaskulären Gruppe auf. Ein früher endovaskulärer Vorteil durch risikoarme Komplikationen wurde im Langzeitverlauf durch risikoreiche Komplikationen wie sekundäre Rupturen und Stentgraftinfektionen aufgehoben. Background: Abdominal aortic aneurysms can nowadays be treated either by open surgery with a vascular prosthesis or endovascularly with a stent graft. In recent years, endovascular therapy has established itself as an important pillar alongside the surgical variant. The development of new devices and specially manufactured endovascular stent grafts has also considerably expanded their field of application. This retrospective study was conducted to compare the two procedures in terms of their outcome at the certified vascular centre of the University Hospital in Homburg. Methods: All patients with an abdominal aortic aneurysm who were treated with one of the forms of therapy at the Vascular Centre of the University Hospital in Homburg between 1 January 2014 and 30 April 2019 were included in the data collection. The group allocation was not randomised. Within each group, a further distinction was made between patients with ruptured and non-ruptured aneurysms. Demographic, aneurysm-related, procedural and clinical data were analysed for the direct comparison. In addition, the length of the overall inpatient stay and intensive care stay, the incidence of complications and the range of complications as well as the incidence of reinterventions/reoperations and the primary hospital mortality were compared. Results: Of a total of 185 patients, 115 underwent endovascular therapy. The remaining 70 patients were treated by open surgery. On average, the surgically treated patients spent 3 days longer in the intensive care unit (p<0.001) and were discharged from hospital an average of 4 days later (p<0.001). Procedure-associated complications and reinterventions occurred more frequently in the endovascular group during primary hospitalisation (complications: EVAR: 75.7%; OP: 34.3%; p<0.001 // reinterventions: EVAR: 33.9%; OP: 27.1%; p=0.336). The most common endovascular complication observed in this case was the occurrence of an endoleak (68/115 patients; 59.1%) (over 85 per cent grade I of the Clavien-Dindo classification). Intestinal ischaemia (11/70 patients; 15.7%) and abdominal compartment syndromes (6/70 patients; 8.6%) were the most common surgical complications (grade IIIB to grade V of the Clavien-Dindo classification). Even after discharge procedure-associated complications and reinterventions were detected more frequently in the endovascular group (complications: EVAR: 19.1%; OP: 11.4%; p=0.218 // reinterventions: EVAR: 16.5%; OP: 10%; p=0.216). The leading endovascular complication was again the occurrence of an endoleak (8/115 patients; 7.0%) (mainly grade IIIA of the Clavien-Dindo classification). However, more serious complications such as secondary ruptures and stent graft infections also occurred in the long-term course (grade IIIB to grade IVB of the Clavien-Dindo classification). In the surgical group, incisional hernias were the most common complication after inpatient discharge (6/70 patients; 8.6%) (grade IIIB of the Clavien-Dindo classification). With regard to mortality during primary hospitalisation, the mortality rate was significantly lower in the endovascular group (EVAR: 3.5%; OP: 20%; p=0.001). However, an uneven group distribution of ruptured aneurysms, which are associated with an increased mortality risk, should be noted. The rate of ruptured aneurysms was 27.1 percent in the surgical group and 7.8 percent in the endovascular group. Conclusions: The EVAR group had a significantly lower hospital mortality rate and a significantly shorter hospital stay. However, it also recorded a significantly lower rate of ruptured aneurysms. Reinterventions and procedure-associated occurred more frequently in the endovascular group. An early endovascular advantage due to low-risk complications was cancelled out in the long-term course by high-risk complications such as secondary ruptures and stent graft infections.
Abstract Open versus interventional aortic repair for abdominal aortic aneurysm: Analysis and comparison of two procedures in a certified and interdisciplinary vascular centre Background: Abdominal aortic aneurysms can nowadays be treated either by open surgery with a vascular prosthesis or endovascularly with a stent graft. In recent years, endovascular therapy has established itself as an important pillar alongside the surgical variant. The development of new devices and specially manufactured endovascular stent grafts has also considerably expanded their field of application. This retrospective study was conducted to compare the two procedures in terms of their outcome at the certified vascular centre of the University Hospital in Homburg. Methods: All patients with an abdominal aortic aneurysm who were treated with one of the forms of therapy at the Vascular Centre of the University Hospital in Homburg between 1 January 2014 and 30 April 2019 were included in the data collection. The group allocation was not randomised. Within each group, a further distinction was made between patients with ruptured and non-ruptured aneurysms. Demographic, aneurysm-related, procedural and clinical data were analysed for the direct comparison. In addition, the length of the overall inpatient stay and intensive care stay, the incidence of complications and the range of complications as well as the incidence of reinterventions/reoperations and the primary hospital mortality were compared. Results: Of a total of 185 patients, 115 underwent endovascular therapy. The remaining 70 patients were treated by open surgery. On average, the surgically treated patients spent 3 days longer in the intensive care unit (p<0.001) and were discharged from hospital an average of 4 days later (p<0.001). 4 Abstract Procedure-associated complications and reinterventions occurred more frequently in the endovascular group during primary hospitalisation (complications: EVAR: 75.7%; OP: 34.3%; p<0.001 // reinterventions: EVAR: 33.9%; OP: 27.1%; p=0.336). The most common endovascular complication observed in this case was the occurrence of an endoleak (68/115 patients; 59.1%) (over 85 per cent grade I of the Clavien-Dindo classification). Intestinal ischaemia (11/70 patients; 15.7%) and abdominal compartment syndromes (6/70 patients; 8.6%) were the most common surgical complications (grade IIIB to grade V of the Clavien-Dindo classification). Even after discharge procedure-associated complications and reinterventions were detected more frequently in the endovascular group (complications: EVAR: 19.1%; OP: 11.4%; p=0.218 // reinterventions: EVAR: 16.5%; OP: 10%; p=0.216). The leading endovascular complication was again the occurrence of an endoleak (8/115 patients; 7.0%) (mainly grade IIIA of the Clavien-Dindo classification). However, more serious complications such as secondary ruptures and stent graft infections also occurred in the long-term course (grade IIIB to grade IVB of the Clavien-Dindo classification). In the surgical group, incisional hernias were the most common complication after inpatient discharge (6/70 patients; 8.6%) (grade IIIB of the Clavien-Dindo classification). With regard to mortality during primary hospitalisation, the mortality rate was significantly lower in the endovascular group (EVAR: 3.5%; OP: 20%; p=0.001). However, an uneven group distribution of ruptured aneurysms, which are associated with an increased mortality risk, should be noted. The rate of ruptured aneurysms was 27.1 percent in the surgical group and 7.8 percent in the endovascular group. Conclusions: The EVAR group had a significantly lower hospital mortality rate and a significantly shorter hospital stay. However, it also recorded a significantly lower rate of ruptured aneurysms. Reinterventions and procedure-associated occurred more frequently in the endovascular group. An early endovascular advantage due to low-risk complications was cancelled out in the long-term course by high-risk complications such as secondary ruptures and stent graft infections.
Link to this record: urn:nbn:de:bsz:291--ds-455408
hdl:20.500.11880/40230
http://dx.doi.org/10.22028/D291-45540
Advisor: Glanemann, Matthias
Date of oral examination: 17-Jun-2025
Date of registration: 4-Jul-2025
Faculty: M - Medizinische Fakultät
Department: M - Chirurgie
Professorship: M - Prof. Dr. Matthias Glanemann
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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