Randomisierte Studienlage zur Therapie des Bauchaortenaneurysmas

In four studies (EVAR-1, DREAM, OVER and ACE) on the treatment of asymptomatic infrarenal abdominal aortic aneurysms (AAA) patients were randomly allocated to either endovascular or surgical treatment. Patients with an AAA ≥5 cm, physical fitness and anatomical suitability were included for endovascular aortic repair (EVAR). The EVAR procedure for AAA showed a lower risk of perioperative mortality but was associated with a higher cardiovascular and aneurysm-related complication rate. In mid-term and long-term follow-up there were no differences in survival after EVAR and open aortic repair (OAR). While OAR was associated with higher cardiovascular perioperative mortality, EVAR demonstrated higher mortality in the follow-up period due to cardiac and aneurysm-related complications. Both treatment options can therefore be considered as equal and can both be offered to patients. The EVAR procedure should be the first choice of treatment of AAA in physically fit patients with suitable anatomy and OAR should be preferred when EVAR does not seem to be technically feasible or for patients where lifelong surveillance is not possible. No significant differences were observed regarding quality of life, sexual dysfunction or costs of treatment.