Hovedpulsåren, utposning: Behandling
Målet med behandlingen er reparere hovedpulsåren hvis det er fare for at den kan sprekke, det vil si hvis et aneurisme i bukaorta er videre enn 5,5 cm. Dersom aneurismet har sprukket, er akutt operasjon nødvendig for å redde livet til pasienten.
Når det er påvist aneurisme, anbefales regelmessige kontroller med ultralyd for å følge med eventuell vekst og for å kunne operere i tide, det vil si før utposningen sprekker.
Behandlingen er operasjon som kan foregå enten ved åpen operasjon eller ved innvendig armering av åren. Ved åpen operasjon fjernes den ødelagte delen av aorta og erstattes med en kunstig åre, en såkalt karprotese. Noen aneurismer kan behandles med en innvendig armering (stent), som settes inn med et kateter som føres inn fra lysken.
Åpen kirurgi er helt nødvendig ved lekkasje eller sprekkdannelse i aneurismet. Andre grunner til kirurgi kan være smerter, passasjehinder i urinledere på grunn av aneurismet, blodpropp avgått fra aneurismet. Dersom kontroller viser at aneurismet vokser (mer enn 1 cm per år) eller størrelsen er over 5,5 cm, så er det også grunn for operasjon. Dette er store og omfattende inngrep med fare for komplikasjoner.
Aneurisme på hovedpulsåren er hos mange et tegn på at blodårene også ellers i kroppen kan være skadet av åreforkalkning. Det er derfor svært viktig å bremse denne åreforkalkningsprosessen med de midler som finnes. Dette betyr at man må slutte å røyke - dette er helt avgjørende både for videre utvikling av sykdommen og for å tåle en eventuell operasjon. Dessuten er det aktuelt med kolesterolsenkende behandling, og nøye blodtrykksbehandling til alle med forhøyet blodtrykk.
Dette dokumentet er basert på det profesjonelle dokumentet Aortaaneurismer . Referanselisten for dette dokumentet vises nedenfor
- Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 2014; 35: 2873-2926. pmid:25173340 PubMed
- Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet 2005; 365: 1577-89. PubMed
- Kniemeyer HW, Kessler T, Reber PU, Ris HB, Hakki H and Widmer MK. Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score. Eur J Vasc Endovasc Surg 2000; 19: 190-6. PubMed
- Thijssen CGE, Mutluer FO, van der Torn JE, et al. Longitudinal changes of thoracic aortic diameters in the general population aged 55 years or older. Heart 2022. pmid:35483871 PubMed
- Wanhainen A, Verzini F, Herzeele IV, 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. pmid:30528142 PubMed
- Frønsdal KB, Svensjö S, Movik E, et al. Abdominalt aortaaneurisme (AAA) screening av menn i alder 65 år. Folkehelseinstituttet 2020. www.fhi.no
- Duncan JL, Harrild KA, Iversen L, et al. Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study. BMJ 2012; 344: e2958. BMJ (DOI)
- Detaint D, Michelena HI, Nkomo VT, et al. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative stsudy with Marfan syndrome and degenerative aortopathy. Heart 2013. doi:10.1136/heartjnl-2013-304920 DOI
- Wahlgren CM, Larsson E, Magnusson PK, et al. Genetic and environmental contributions to abdominal aortic aneurysm development in a twin population. J Vasc Surg 2010; 51: 3-7. pmid:19939604 PubMed
- Brown JP, Wing K, Leyrat C, et al. Association between fluoroquinolone use and hospitalization with aortic aneurysm or aortic dissection. JAMA Cardiol 2023. pmid:37585175 PubMed
- Huh K, Kang M, Jung J Lack of association between fluoroquinolone and aortic aneurysm or dissection. Eur Heart J. 2023. PMID: 37724037 PubMed
- Socialstyrelsen. Bukaortaaneurysm – screening med engångsundersökning med ultraljud www.socialstyrelsen.se
- Lindholt JS, Søgaard R, Rasmussen LM, et al. Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. N Engl J Med. 2022;387(15):1385-1394. PMID: 36027560 PubMed
- Cosford PA, Leng GC, Thomas J. Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002945. DOI: 10.1002/14651858.CD002945.pub2. Accessed 03 April 2024. The Cochrane Library
- Ali MU, Fitzpatrick-Lewis D, Miller J, et al. Screening for abdominal aortic aneurysm in asymptomatic adults. J Vasc Surg 2016 Dec; 64(6): 1855-1868. pmid:27871502 PubMed
- Metcalfe D, Holt PJE, Thompson MM. The management of abdominal aortic aneurysms. BMJ 2011; 342: d1384. BMJ (DOI)
- Thompson SG, Ashton HA, Gao L, et al. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 2009; 338: b2307. BMJ (DOI)
- Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160: 321-9. PMID: 24473919 PubMed
- Guirguis-Blake JM, Beil TL, Senger CA, et al. Primary Care Screening for Abdominal Aortic Aneurysm Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322: 2219-38. doi:10.1001/jama.2019.17021 DOI
- Upchurch GR, Schaub TA. Abdominal aortic aneurysm. Am Fam Physician 2006; 73: 1198-204. PubMed
- Ramanath VS, Oh JK, Sundt TM 3rd, Eagle KA. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc. 2009 May;84(5):465-81. PMID: 19411444 PubMed
- Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB and Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 2000; 160: 833-6. PubMed
- Blois B. Office-based ultrasound screening for abdominal aortic aneurysm. Can Fam Physician. 2012;58(3):e172–e178.
- Sprouse LR, Meier GH, Parent FN, et al. Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? J Vasc Surg 2004; 40: 443-7. PubMed
- United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002; 346: 1445 - 52. PubMed
- Wilson KA, Lee AJ, Lee AJ, Hoskins PR, Fowkes FG, Ruckley CV et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg 2003; 37: 112 - 7. PubMed
- Brown PM, Zelt DT, Sobolev B. The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg 2003; 37: 280 - 4. PubMed
- The UK Small Aneurysm Trial Participants. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998; 352: 1649-55 PubMed
- Wesche J. Epidemiologi, utredning og behandlingsindikasjon ved aortaaneurisme. Tidsskr Nor Legeforen 2009; 129: 2124-6. Tidsskrift for Den norske legeforening
- Lederle FA (ed). Abdominal aortic aneurysm - open versus endovascular repair. N Engl J Med 2004; 351: 1677-9. New England Journal of Medicine
- Vetrhus M, Viddal B, Loose H, Neverdal NO, Nordang E. Abdominale aortaaneurismer - endovaskulær og åpen kirurgi. Tidsskr Nor Legeforen 2009; 129: 2248-51. Tidsskrift for Den norske legeforening
- Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM and Powell JT. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 2004; 110: 16-21. Circulation
- Hariri E, Matta M, Layoun H, et al. Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes. JAMA Netw Open 2023; 6: 2347296. pmid:38085542 PubMed
- Golledge J, Singh TP Effect of blood pressure lowering drugs and antibiotics on abdominal aortic aneurysm growth: a systematic review and meta-analysis. Heart. 2020. PMID: 33199361 PubMed
- Baxter BT, Matsumura J, Curci JA, et al. Effect of Doxycycline on Aneurysm Growth Among Patients With Small Infrarenal Abdominal Aortic Aneurysms: A Randomized Clinical Trial. JAMA 2020; 323: 2029. pmid:PMID: 32453369 PubMed
- Rughani G, Robertson L, Clarke M. Medical treatment for small abdominal aortic aneurysms. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD009536. DOI: 10.1002/14651858.CD009536.pub2. Accessed 03 April 2024 The Cochrane Library
- Isselbacher EM, Preventza O, Black Jr 3rd H, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 146: e334-e482. pmid:36322642 PubMed
- Laxdal E, Amundsen SR, Pedersen G, et al. Bruk av stentgraft ved abdominale aortaaneurismer. Tidsskr Nor Lægeforen 2004; 124: 1237-9. PubMed
- Lundbom J, Hatlinghus S, Lange C, et al. Ni års erfaring med endovaskulær behandling av abdominale aortaaneurismer. Tidsskr Nor Lægeforen 2004; 124: 2757-9. PubMed
- Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm. JAMA 2009; 302: 1535-42. Journal of the American Medical Association
- De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1881-9. New England Journal of Medicine
- The United Kingdom EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1863-71. PubMed
- EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365: 2179-86. PubMed
- EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005; 365: 2187-92. PubMed
- Jackson RS, Chang DC, Freischlag JA. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA 2012; 307: 1621-8. Journal of the American Medical Association
- Kent KC, Zwolak RM, Egorova NN, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 2010; 52: 539. pmid:20630687 PubMed
- Talvitie M, Stenman M, Roy J, Leander K, Hultgren R. Sex Differences in Rupture Risk and Mortality in Untreated Patients With Intact Abdominal Aortic Aneurysms. J Am Heart Assoc. 2021;10(5):e019592. PMID:33619974.
- Solomon MD, Leong T, Sung SH, et al. Association of Thoracic Aortic Aneurysm Size With Long-term Patient Outcomes The KP-TAA Study. JAMA Cardiol 2022. pmid:36197675 PubMed
- Myhre HO, Ødegård A, Winnerkvist A, Stenseth R. Torakoabdominale aortaaneurismer - åpen kirurgi og endovaskulær behandling. Tidsskr Nor Legeforen 2009; 129: 2127-30. Tidsskrift for Den norske legeforening
- Ulug P, Powell JT, Martinez M-MA, Ballard DJ, Filardo G. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD001835. DOI: 10.1002/14651858.CD001835.pub5. Accessed 03 April 2024 The Cochrane Library
- Schlösser FJ, Vaartjes I, van der Heiden GJ, et al. Mortality after elective abdominal aortic aneurysm repair. Ann Surg 2010; 25: 158-64. PubMed
- Schermerhorn ML, O'Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysm in the medicare population. N Engl J Med 2008; 358: 464-74. New England Journal of Medicine
- Wilmink TB, Quick CR, Hubbard CS and Day NE. The influence of screening on the incidence of ruptured abdominal aortic aneurysms. J Vasc Surg 1999; 30: 203-8. PubMed
- Pleumeekers HJCM, Hoes AW, van der Does E, Van Urk H, Grobbee DE. Epidemiology of abdominal aortic aneurysms. Eur J Vasc Surg 1994; 8: 119-28. PubMed
- Reite A, Søreide K, Ellingsen CL, et al. Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality. J Vasc Surg 2015; 61: 1168-74. pmid:25659456 PubMed
- Grootenboer N, van Sambeek MR, Arends LR, Hendriks JM, Hunink MG, Bosch JL. Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg 2010; 97: 1169-79. PubMed
- Coggia M, JaverliatI, Centa Di et al. Total laparoscopic infrarenal aortic aneurysm repair: preliminary results. J Vasc Surg 2004; 40: 448-54. PubMed