title: Endovascular abdominal aneurysm repair: trends in Germany.
abstract: BACKGROUND
  As a minimally invasive technique endovascular aneurysm repair (EVAR) reduces the risk of mortality and should be the preferred technique used in older patients. We analysed trends in endovascular and open surgical procedures in patients hospitalized for abdominal aortic aneurysm (AAA) in Germany.
  
  
  METHODS
  We used national statistics (DRG statistics) published by the Federal Office of Statistics in Germany to calculate the incidence of patients hospitalised with ruptured (rAAA) and elective (eAAA) AAA. In addition, annual procedure rates of endovascular (EVAR) procedures were calculated.
  
  
  RESULTS
  Incidence rates of eAAA per 100,000 males (females) showed a small increase from 2006 to 2007 but remained almost unchanged with 74.8 (8.8) in 2007 and 74.5 (9.8) in 2009. Incidence rates of rAAA per 100 000 males remained unchanged but showed a decreasing trend in females. The rate of people treated by EVAR increased form 2006 to 2009: in males from 24.0 % to 40.3 % and in females from 17.3 % to 31.0 %. In younger males (55 - 60 years) the increase in those who received EVAR was smaller (from 22.1 % to 33.9 %) than in older males (85 - 90 years) (from 20.4 to 41.6 %). Despite a clear increase in the use of EVAR from 2006 to 2009 there is only a small trend in reduction of the death rates which is more pronounced in rAAA.
  
  
  CONCLUSIONS
  There has been a relevant increase in EVAR procedures for the treatment of AAA in Germany in recent years. Parallel to this increase of EVAR, aneurysm-related in-hospital deaths seem be declining slightly. A causal relationship between these trends remains to be proven.
authors: Department of Vascular Medicine, HELIOS Klinikum Krefeld, Germany.
authors: F
authors: F
authors: Santosa
authors: T
authors: T
authors: Moysidis
authors: T
authors: T
authors: Nowak
authors: C
authors: C
authors: Heilmaier
authors: C
authors: C
authors: Berg
authors: B
authors: B
authors: Luther
authors: K
authors: K
authors: Kröger
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D017558:Elective Surgical Procedures / Q000639:trends; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome