Összefoglaló. Bevezetés: Az elmúlt évtizedekben számos országban jelentős mértékben változott a hasi aortaaneurysmák sebészi kezelése az eredményesebb ellátás céljából: endovascularis beavatkozások terjedése, nagy betegforgalmú aortacentrumok kialakítása. Célkitűzés: A Magyarországon, infrarenalis aortaaneurysmák miatt végzett beavatkozások rövid távú eredményeinek elemzése elsősorban műtéti technika (endovascularis vs. nyitott aortareconstructio), intézeti betegforgalom (kis vs. nagy betegforgalmú intézet) és időszak (2010–2014 vs. 2015–2019) alapján. Módszer: A Nemzeti Érsebészeti Regiszterben 2010. 01. 01. és 2019. 12. 31. között prospektíven rögzített multicentrikus adatok retrospektív feldolgozása. Eredmények: A regiszterben 3206 infrarenalis aortaaneurysma-műtétet rögzítettek. A második öt évben jelentősen nőtt az endovascularis aortareconstructio aránya a nyitotthoz képest (p<0,0001), illetve a nagy betegforgalmú intézetek szignifikánsan több rupturált aortaaneurysmát láttak el, mint a kis betegforgalmú intézetek (p<0,0001) az első öt évhez viszonyítva. A perioperatív mortalitás rupturált aortaaneurysma miatt a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekkel szemben az első öt évben (p = 0,0011), illetve a nagy betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a nyitottal szemben a második öt évben (p = 0,029). A nem rupturált aortaaneurysma-műtétek perioperatív mortalitása a nagy betegforgalmú intézetekben végzett nyitott aortareconstructio esetén szignifikánsan alacsonyabb volt a kis betegforgalmú intézetekhez képest az első és a második öt évben is (p = 0,0007; p = 0,004). Mind a nagy, mind a kis betegforgalmú intézetekben végzett endovascularis aortareconstructio esetén szignifikánsan alacsonyabb volt a perioperatív mortalitás a második öt évben (p<0,0001; p<0,0001). A rupturált és a nem rupturált aortaaneurysmák perioperatív mortalitásának független rizikófaktora az intézetek betegforgalma (p = 0,006; p = 0,004), a betegek életkora (p<0,0001; p = 0,001), a preoperatív renalis megbetegedés (p = 0,007; p = 0,007), a transzfúzióigény (p<0,0001; p<0,0001), illetve nem rupturált aortaaneurysmák esetében a műtéti technika (p<0,0001) is. Következtetés: Endovascularis aortareconstructio és nagy betegforgalmú intézetek esetében szignifikánsan alacsonyabb perioperatív mortalitás érhető el. Orv Hetil. 2021; 162(31): 1233–1243.
Summary. Introduction: The organisation of aortic disease care has changed significantly in many countries over the last decade: centralized, high-volume centers were established. Objective: To analyse the perioperative mortality and the number of the infrarenal aortic aneurysm repairs according to the type of procedure (endovascular vs. open), patient volume (low vs. high) and time period (2010–2014 vs. 2015–2019). Methods: The multicentric data registered prospectively in the Hungarian National Vascular Registry between 01. 01. 2010 and 31. 12. 2019 were analysed retrospectively. Results: 3206 infrarenal aortic aneurysms were recorded. The endovascular-open repair rate was significantly higher (p<0.0001) and the high-volume institutes managed significantly more ruptured aneurysms (p<0.0001) in the second period. The perioperative mortality of the open repair of ruptured aneurysms was significantly lower in the high-volume institutes than in the low-volume ones in the first period (p = 0.0011), and the mortality of endovascular repair was significantly lower compared with open repair in the high-volume institutes in the second period (p = 0.029). The perioperative mortality of the open repair of non-ruptured aneurysm was significantly lower in the high-volume institutes in both periods (p = 0.0007; p = 0.004). Furthermore, the mortality of endovascular repair was significantly lower compared with open repair both in the high- and the low-volume institutes in the second period (p<0.0001; p<0.0001). Patient volume (p = 0.006; p = 0.004), age (p<0.0001; p = 0.001), preoperative renal insufficiency (p = 0.007; p = 0.007) and the need of blood transfusion (p<0.0001; p<0.0001) were independent risk factors of the perioperative mortality of ruptured and non-ruptured aneurysms. Type of the procedure was also an independent risk factor in the case of non-ruptured aneurysms (p<0.0001). Conclusion: Endovascular repair and aortic surgery in the high-volume institutes result in significantly lower perioperative mortality. Orv Hetil. 2021; 162(31): 1233–1243.
Waton S, Johal A, Groene O, et al. Outcomes after elective repair of infra-renal abdominal aortic aneurysm. The Royal College of Surgeons of England, London, 2013. Available from: https://www.vsqip.org.uk/content/uploads/2017/06/Outcomes-after-Elective-Repair-of-Infra-renal-Abdominal-Aortic-Aneurysm.pdf [accessed: December 20, 2020].
Gibbons C, Björck M, Jensen LP, et al. The second vascular surgery database report. Eur Soc Vasc Surg. 2008. Available from: https://www.vascularsociety.org.uk/_userfiles/pages/files/Document%20Library/ESVS_VASCUNET_REPORT_2008_BW.pdf [accessed: December 20, 2020].
Menyhei G, Simó G, Szeberin Z, et al. Establishment and functioning of the Vascular Surgery Registry in Hungary. [Az Érsebészeti Regiszter működtetése során szerzett tapasztalatok.] Orv Hetil. 2014; 155: 755–760. [Hungarian]
Grip O, Mani K, Altreuther M, et al. Contemporary treatment of popliteal artery aneurysms in 14 countries: a Vascunet report. Eur J Vasc Endovasc Surg. 2020; 60: 721–729.
Lees T, Troëng T, Thomson IA, et al. International variations in infrainguinal bypass surgery – a Vascunet report. Eur J Vasc Endovasc Surg. 2012; 44: 185–192.
Behrendt CA, Sigvant B, Szeberin Z, et al. International variations in amputation practice: a VASCUNET report. Eur J Vasc Endovasc Surg. 2018; 56: 391–399.
Mani K, Venermo M, Beiles B, et al. Regional differences in case mix and peri-operative outcome after elective abdominal aortic aneurysm repair in the VASCUNET database. Eur J Vasc Endovasc Surg. 2015; 49: 646–652.
Venermo M, Wang G, Sedrakyan A, et al. Editor’s Choice – Carotid Stenosis Treatment: Variation in International Practice Patterns. Eur J Vasc Endovasc Surg. 2017; 53: 511–519.
Szeberin Z, Hidi L, Kováts T, et al. Report of the 2013 data of the Hungarian Vascular Surgery Registry. [Az Érsebészeti Regiszter 2013-as adatainak elemzése.] Magy Seb. 2014; 67: 362–371. [Hungarian]
Hidi L, Menyhei G, Kováts T, et al. Report of the Hungarian Vascular Surgery Registry’s data of infrarenal aortic aneurysms (2010–2014). [Magyarországon végzett infrarenalis aortaaneurysma-műtétek eredményei az Érsebészeti Regiszter adatai alapján (2010–2014).] Orv Hetil. 2015; 156: 1991–2002. [Hungarian]
Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019; 57: 8–93. [Erratum: Eur J Vasc Endovasc Surg. 2020; 59: 494.]
Smith ME, Sutzko DC, Davis FM, et al. Volume standards for open abdominal aortic aneurysm repair are not associated with improved clinical outcomes. Ann Vasc Surg. 2020; 62: 1–7.
Sawang M, Paravastu SC, Liu Z, et al. The relationship between aortic aneurysm surgery volume and peri-operative mortality in Australia. Eur J Vasc Endovasc Surg. 2019; 57: 510–519.
Leighton P, Doe M, Pathak S, et al. Immediate impact of centralization on abdominal aortic aneurysm repair outcomes for a vascular network in the south west of England: a retrospective cohort study. Ann Surg. 2019; 269: 172–176.
Austvoll-Dahlgren A, Underland V, Straumann GH, et al. Patient volume and quality in surgery for abdominal aortic aneurysm. [Pasientvolum og kvalitet ved kirurgi for abdominale aortaaneurismer.] Tidsskr Nor Laegeforen. 2017; 137: 529–537. [Norwegian]
Yamaguchi T, Nakai M, Sumita Y, et al. The impact of institutional case volume on the prognosis of ruptured aortic aneurysms: a Japanese nationwide study. Interact Cardiovasc Thorac Surg. 2019; 29: 109–116.
Greenleaf EK, Hollenbeak CS, Aziz F. Outcomes after ruptured abdominal aortic aneurysm repair in the era of centralized care. J Vasc Surg. 2020; 71: 1148–1161.
Eckstein HH, Bruckner T, Heider P, et al. The relationship between volume and outcome following elective open repair of abdominal aortic aneurysms (AAA) in 131 German hospitals. Eur J Vasc Endovasc Surg. 2007; 34: 260–266.
Scali ST, Beck AW, Sedrakyan A, et al. Hospital volume association with abdominal aortic aneurysm repair mortality: analysis of the International Consortium of Vascular Registries. Circulation 2019; 140: 1285–1287.
Budtz-Lilly J, Björck M, Venermo M, et al. Editor’s Choice – The impact of centralisation and endovascular aneurysm repair on treatment of ruptured abdominal aortic aneurysms based on international registries. Eur J Vasc Endovasc Surg. 2018; 56: 181–188.
Tripodi P, Mestres G, Riambau V, et al. Impact of centralisation on abdominal aortic aneurysm repair outcomes: early experience in Catalonia. Eur J Vasc Endovasc Surg. 2020; 60: 531–538.
Zettervall SL, Schermerhorn ML, Soden PA, et al. The effect of surgeon and hospital volume on mortality after open and endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2017; 65: 626–634.
Holt PJE, Michaels JA. Does volume directly affect outcome in vascular surgical procedures? Eur J Vasc Endovasc Surg. 2007; 34: 386–389.
Koelemay MJ, Vahl AC. Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery. Br J Surg. 2007; 94: 395–403. Holt PJ, Poloniecki JD, Gerrard D, et al. Authors’ reply. Br J Surg. 2007; 94: 1041.
Katsargyris A, Klonaris C, Verhoeven ELG. Is volume important in aneurysm treatment outcome? J Cardiovasc Surg (Torino). 2017; 58: 187–193.
Bahia SS, Ozdemir BA, Oladokun D, et al. The importance of structures and processes in determining outcomes for abdominal aortic aneurysm repair: an international perspective. Eur Hear J Qual Care Clin Outcomes 2015; 1: 51–57.
Nimptsch U, Mansky T. Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014. BMJ Open 2017; 7: e016184.
Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018; 67: 2–77.e2.