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Paradigm shifts in abdominal aortic aneurysm management based on vascular registries
Author(s) -
Guerre L.,
Venermo M.,
Mani K.,
Wanhainen A.,
Schermerhorn M.
Publication year - 2020
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.13051
Subject(s) - medicine , abdominal aortic aneurysm , laparotomy , generalizability theory , aortic aneurysm , endovascular aneurysm repair , randomized controlled trial , perioperative , aneurysm , population , vascular surgery , surgery , intensive care medicine , general surgery , cardiac surgery , statistics , mathematics , environmental health
Abdominal aortic aneurysm (AAA) is a relatively common and potentially fatal disease. The management of AAA has undergone extensive changes in the last two decades. High quality vascular surgical registries were established early and have been found to be instrumental in the evaluation and monitoring of these changes, most notably the wide implementation of minimally invasive endovascular surgical technology. Trends over the years showed the increased use of endovascular aneurysm repair (EVAR) over open repair, the decreasing perioperative adverse outcomes and the early survival advantage of EVAR. Also, data from the early EVAR years changed the views on endoleak management and showed the importance of tracking the implementation of new techniques. Registry data complemented the randomized trials performed in aortic surgery by showing the high rate of laparotomy‐related reinterventions after open repair. Also, they are an essential tool for the understanding of outcomes in a broad patient population, evaluating the generalizability of findings from randomized trials and analysing changes over time. By using large‐scale data over longer periods of time, the importance of centralization of care to high‐volume centres was shown, particularly for open repair. Additionally, large‐scale databases can offer an opportunity to assess practice and outcomes in patient subgroups (e.g. treatment of AAA in women and the elderly) as well as in rare aortic pathologies. In this review article, we point out the most important paradigm shifts in AAA management based on vascular registry data.