Status quo der Gefäßchirurgie

Eckstein, H.‐H.; Knipfer, Eva

doi:10.1007/s00104-007-1367-8

Cited by 20 publications

(2 citation statements)

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“…The specialty of vascular surgery has continued to grow over the past 20 years. This is demonstrated by the steady increase in the use of vascular surgery services, the increase in the number of vascular surgery departments and clinics employing specialists in vascular surgery as well as by the increasing number of newly qualified specialists, and the increasing number of specialists working in vascular surgery, fortunately also as senior and chief physicians [ 10 , 13 ]. The treatment of arterial disease and varicose veins is predominantly performed in specialized departments of vascular surgery or general surgery units.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and inpatient treatment of vascular diseases in Germany

2015

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BackgroundNon-cardiac vascular diseases account for approximately 10 % of the total burden of disease in the German population as measured in disability-adjusted life years (DALY). Thus, from the social perspective, much attention should be paid to optimization of the provision of vascular services especially in elderly people.ObjectivesThis article describes the structure of inpatient care and the provision of vascular treatment as well as age- and gender-specific hospital incidence rates of vascular diseases in Germany between 2005 and 2013.Materials and methodsSecondary data analysis is based on basic data from German hospitals as well as nationwide aggregated data from the diagnosis-related groupsʼ statistics from the Federal Statistical Office.ResultsSince 2005, the incidence of non-cardiac vascular diseases has increased and showed a significant dependency on sex and age. In general, men were affected consistently more frequently by vascular diseases. In contrast, hospital admission rates due to varicose veins or acute ischemia of the legs were higher in women. Treatment of arterial diseases was performed predominantly in general surgery units or departments for vascular surgery. From 1991 to 2013, the number of hospitals employing specialists for vascular surgery almost doubled, and the number of vascular surgeons working full-time in German hospitals was nearly tripled. Endovascular approaches were used particularly for revascularization of peripheral arteries as well as aortic aneurysm repair. In contrast, carotid surgery as well as peripheral embolectomy were predominately performed using open surgical techniques.ConclusionsSince 1991, the increasing need for vascular services for patients has been met by continuously growing structures for the provision of vascular surgical treatment; however, the suitability and efficiency of provision of vascular services could only be assessed in an appropriate way by using more differentiated and disaggregated data.Additional material available onlineAdditional information is available in the online version of this article (doi:10.1007/s00772-015-0095-5).

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Section: Discussionmentioning

confidence: 99%

Epidemiology and inpatient treatment of vascular diseases in Germany

2015

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“…Prevalence of AAA with a maximum diameter of more than 5.5 cm and therefore clinical indication for surgery is high with 1-2% within population over 60 years and 10% within male population over 80 years (Eckstein and Knipfer 2007). In case of rupture, nine out of ten patients die before reaching the hospital and mortality rates of patients with ruptured AAA treated operatively vary from 35 to 70% (Ockert et al 2007).…”

Section: Introductionmentioning

confidence: 98%

Impact of calcifications on patient-specific wall stress analysis of abdominal aortic aneurysms

Maier

Gee

Reeps

et al. 2010

Biomech Model Mechanobiol

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As a degenerative and inflammatory desease of elderly patients, about 80% of abdominal aortic aneurysms (AAA) show considerable wall calcification. Effect of calcifications on computational wall stress analyses of AAAs has been rarely treated in literature so far. Calcifications are heterogeneously distributed, non-fibrous, stiff plaques which are most commonly found near the luminal surface in between the intima and the media layer of the vessel wall. In this study, we therefore investigate the influence of calcifications as separate AAA constituents on finite element simulation results. Thus, three AAAs are reconstructed with regard to intraluminal thrombus (ILT), calcifications and vessel wall. Each patient-specific AAA is simulated twice, once including all three AAA constituents and once neglecting calcifications as it is still common in literature. Parameters for constitutive modeling of calcifications are thereby taken from experiments performed by the authors, showing that calcifications exhibit an almost linear stress-strain behavior with a Young's modulus E ≥ 40 MPa. Simulation results show that calcifications exhibit significant load-bearing effects and reduce stress in adjacent vessel wall. Average stress within the vessel wall is reduced by 9.7 to 59.2%. For two out of three AAAs, peak wall stress decreases when taking calcifications into consideration (8.9 and 28.9%). For one AAA, simulated peak wall stress increases by 5.5% due to stress peaks near calcification borders. However, such stress singularities due to sudden stiffness jumps are physiologically doubtful. It can further be observed that large calcifications are mostly situated in concavely shaped regions of the AAA wall. We deduce that AAA shape is influenced by existent calcifications, thus crucial errors occur if they are neglected in computational wall stress analyses. A general increase in rupture risk for calcified AAAs is doubted.

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