The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking full and careful consideration of the relevant official updated recommendations or guidelines issued by the competent public health authorities in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
Abstract For uncomplicated abdominal aortic aneurysms (AAAs), small ones (<55 mm in diameter) are generally subject to surveillance, while larger ones (≥55 mm in diameter) should be considered for aneurysm repair. There is no benefit of a timely repair for small AAAs, regardless of repair method and patient age. Aortic aneurysm, however, is a surrogate for cardiovascular morbidity, thus risk factor management and secondary preventive drug treatment is essential in all AAA patients. Several studies have attempted to address the optimal pace for ultrasound surveillance of small aneurysms and based on a recent large meta-analysis, intervals of 3 years, 1 year, and 6 months were proposed for AAAs measuring 30–39, 40–49, and 50–54 mm, respectively. In patients with a large aneurysm, open or endovascular aortic repair (EVAR) is the primary treatment option. The goals for both repair techniques are identical, although the treatment strategy is completely different. During EVAR, the aneurysm is left intact, and the blood flow is excluded from the aneurysm by catheter-based deployment of a stent graft; thus, successful EVAR procedures are bound to specific anatomical conditions. In cases that are anatomically and physiologically eligible for both conventional EVAR and open repair, EVAR was associated with a substantial early survival advantage; this benefit, however, was lost over time. The rate of late rupture was significantly higher after endovascular repair than after open repair. In patients with a ruptured AAA, an individual patient data meta-analysis from three randomized controlled trials reported similar survival to 90 days following an endovascular or open repair strategy.
Beim Karotisstimulator handelt es sich um ein Gerat, welches den Baroreflex-Mechanismus elektrisch aktiviert. Dies hat zur Folge, dass der Sympathikotonus abgeschwacht und das Renin-Angiotensin-Aldosteron-System gedampft wird, was eine Reduktion des Blutdrucks und der Herzfrequenz bewirkt. Die Baroreflex-Aktivierungstherapie (BAT) fuhrt im Langzeitverlauf zu einer dauerhaften durchschnittlichen Senkung des systolischen Blutdrucks von 40–50 mmHg nach vier Jahren. Bei den Patienten konnte ausser der blutdrucksenkenden Wirkung eine Reduktion der Herzmuskeldicke festgestellt werden. Die Wirkung bei Patienten mit Herzinsuffizienz wird zurzeit gepruft. Die Implantation des Gerats gilt als sicher. Der Karotisstimulator ist nun in mehreren europaischen Landern erhaltlich.
Endografts for repair of abdominal aortic aneurysm were first reported in the late 1980s and commercially available grafts were developed rapidly during the 1990s. This prompted a head-to-head comparison of the new, less invasive, endovascular technology with the existing gold standard of open repair. The first and largest randomised trial of open versus endovascular repair for large aneurysms started in the UK in 1999. Other trials comparing open and endovascular repair followed in the Netherlands, France and the US. Only the UK trial has reported long-term follow-up to 10 years. This has shown no statistically significant difference in long-term survival after open or endovascular repair. Aneurysm-related mortality curves converged at six years, which is described as endovascular aortic repair (EVAR) 'catch up' on open repair. It appears that this convergence is probably largely attributable to secondary sac rupture after endovascular repair, which is fatal in about two-thirds of cases. At this point, we have reached a crossroads and only longer-term follow-up data can provide the vital answer to the outcome of endovascular repair in the long run. This article gives a brief overview of the development and the current evidence of endovascular aortic repair and discusses the most important factors that are leading the way to the future of this technology.
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