Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysmsDebus, E.; Heidemann, F.; Gross-Fengels, W.; Mahlmann, A.; Muhl, E.; Pfister, K.; Roth, S.; Stroszczynski, C.; Walther, A.; Weiss, N.; Wilhelmi, M.; Grundmann, R.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0465-x
In this article a brief version of the newly developed S3 guidelines on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms (AAA), which was developed under the auspices of the German Society of Vascular Surgery and VascularMedicine (DGG) is presented. In addition to the DGG, participating professional societies were the German Radiological Society (DRG), German Society for Angiology/Society for Vascular Medicine (DGA), German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), German Society for Ultrasound in Medicine (DEGUM), German Vascular League e.V., German Society for Interventional Radiology (DEGIR), German Society for Anesthesiology and Intensive Care Medicine (DGAI), German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society of Surgery (DGCH). The guidelines are based on a systematic literature search in Medline (PubMed) for the period from 1 January 2000 to 1 January 2017. Important publications from 2017 were also considered. The selection of evidence was made by a multilevel screening process. In addition to the evidence, other criteria were included in the assessment of the recommendation level, such as the consistency of the study results, the clinical relevance of the endpoints and effect sizes, the benefit–risk balance, the applicability of the study results to the patient target group and the care system, the feasibility of the recommendations in everyday life, patient preferences and ethical and legal considerations. All recommendations/findings were approved with strong consensus (approval of >95% of the participating professional societies/associations). Thus, the present text version of the S3 guidelines on AAA represents the view of all participating societies.
International Consortium of Vascular RegistriesVenermo, M.; Sedrakyan, A.; Cronenwett, J.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0475-8
The International Consortium of Vascular Registries (ICVR) has rapidly developed into a global collaborative. Given the importance of vascular devices for public health, this is a priority direction for regulators, manufacturers, payers and patients advocacy groups. It is an innovative effort building on successes achieved in orthopedics and promotes cohesion among international registries. The ICVR will enable a collaboration of stakeholders to create a sustainable global system to evaluate the safety and efficacy of new and existing vascular devices and procedures, while promoting innovation and quality improvement.
Big Data und Real-World-Evidenz in der interdisziplinären PAVK-BehandlungBehrendt, C.-A.; Rieß, H.; Debus, E.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0462-0
Der wissenschaftliche Stellenwert von Register- und Routinedaten als sogenannte Real-World-Evidenz nimmt in der vaskulären Qualitätsentwicklung und Versorgungsforschung kontinuierlich zu. Durch schnell wachsende digitale Datenbestände und lernende Algorithmen zu deren Verarbeitung ergeben sich immer neue Möglichkeiten, die heute als Big Data oder Smart Data bezeichnet werden. Der große Bedarf an weiteren hochwertigen Studien zur Verbesserung der Evidenzbasis in der Behandlung der peripheren arteriellen Verschlusskrankheit kann durch randomisierte und kontrollierte Studien nicht vollständig gedeckt werden, weshalb die Einführung interdisziplinärer Register und die Nutzung von Routinedaten sinnvoll erscheint. Hierbei sollten allerdings die Vorteile und Limitationen gewissenhaft berücksichtigt werden. Vor dem Hintergrund einer grenzüberschreitenden internationalen Qualitätsentwicklung sollte zudem eine konsequente Harmonisierung bestehender Projekte mit Real-World-Evidenz erfolgen.
S2k guidelines for the diagnosis and treatment of typeB aortic dissectionTorsello, G.; Czerny, M.; Grundmann, R.; Krankenberg, H.; Nikol, S.; Puls, R.; Raddatz, A.; Schelzig, H.; Schmieder, R.; Zahn, R.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0489-2
Type B aortic dissection is a relatively rare clinical picture that involves many fields of medicine and requires a multidisciplinary approach. In this report, the disciplines involved constitute the most important aspects of the new S2k guidelines for the diagnosis and treatment of type B aortic dissection. More specifically, the definition and epidemiology, the clinical and technical diagnostic methods, in addition to the imaging methods, are presented, and recommendations for the individual topics based on scientific studies and expert opinion are given. In the guidelines, the various procedures related to the main conservative and surgical treatment regimes in the acute, subacute, and chronic phases of the condition are dealt with.
The Swedish vascular registry Swedvasc 1987–2018Sigvant, B.; Mani, K.; Björck, M.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0473-x
The Swedish vascular registry, Swedvasc, was created in 1987 as a regional registry and achieved national coverage in 1994. This article describes how the registry developed during those 31 years. The aims of the registry were to enhance quality improvement and research within the field of vascular surgery. The registry was validated on several occasions and in 2015 an independent international validation took place, showing both excellent external (no missing cases) and internal validity (comparing the variables in the registry with case records). The Swedvasc was instrumental in the creation of Vascunet in 1997, the international collaboration of vascular registries in Europe, Australia and New Zealand. Enabling international comparisons of indications, techniques and outcomes has proven to be a great force in quality improvement. This collaboration is now turning global, including the North American registry the Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) and hopefully soon also including the Japanese registry. The Swedvasc is used as an integral part of routine healthcare and over 10,000 procedures are registered annually. This provides clinicians, clinics, health authorities and researchers with real-world data from an unselected nationwide population. Registry data have been used to describe patterns of treatment and outcomes over time and for monitoring quality of care locally, nationally and internationally and for quality improvement projects. The clinical data available in Swedvasc provide an important source not only for assessment and development of healthcare but also for research and over 100 original articles based on Swedvasc data have been published. A randomization module has been included in the registry since 2014 and opens up a new clinical trial paradigm; registry-based randomized clinical trials.
Real-World-Evidenz in der Behandlung von VenenerkrankungenNüllen, H.; Noppeney, T.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0476-7
Die Register-Forschung gewinnt unter dem Gesichtspunkt der Versorgungsforschung und der Generierung wirklichkeitsnaher Behandlungsstrategien und Erfolgsbeurteilungen zunehmend an Bedeutung. Ziel dieser Übersichtsarbeit ist die möglichst umfassende Sammlung und Beschreibung der wesentlichen Register zur Gewinnung von Real-World-Daten in der Diagnostik und Behandlung von Erkrankungen des Venensystems im nationalen und internationalen Rahmen. Wesentliche Daten aus diesen Datensammlungen werden auszugsweise dargestellt.
Ernährung und periphere arterielle Verschlusskrankheit – Teil2Daniels, P.; Debus, E.; Grundmann, R.
2018 Gefässchirurgie
doi: 10.1007/s00772-018-0485-6
Die Prävalenz der Mangelernährung, die sich mithilfe des CONUT-Score (Controlling Nutritional Status) und des GNRI (Geriatric Nutritional Risk Index) objektiv feststellen lässt, wird bei peripherer arterieller Verschlusskrankheit (pAVK) und Patienten mit „critical limb ischemia“ (CLI) auf 50–75 % geschätzt. Verschiedene neuere Untersuchungen zeigen, dass Mangelernährung bei pAVK-Patienten, speziell solchen mit kritischer Extremitätenischämie, häufig auftritt und das klinische Outcome nach endovaskulärer Therapie (EVT) negativ beeinflusst. Zudem erwies sich der GNRI bei Aufnahme bei CLI-Patienten als unabhängiger Prädiktor für Mortalität und Amputationen nach EVT. Auch war ein negativer Einfluss auf die perioperative Morbidität und Mortalität nach Bypass-Operation festzustellen. Deshalb sollte es ein therapeutisches Ziel sein, die Mangelernährung dieser Patientenklientel im Rahmen der hausärztlichen Versorgung zu beseitigen.