title: [Patient with ruptured abdominal aortic aneurysm better off with centralized care].
abstract: Current debate on complex medical care in the Netherlands includes the treatment of ruptured abdominal aortic aneurysm (RAAA). Topics of interest are hospital volume, patient selection and the use of minimally invasive but more expensive techniques. Based on two recent randomized trials investigating open and endovascular repair for RAAA, we discuss the advantages and disadvantages of techniques, quality of life and age. We conclude that optimal treatment can only be provided in a vascular centre with 24/7 availability of both open and endovascular repair, a top level intensive care unit and a demonstrable low decline rate for surgery. Age should be abandoned as an eligibility criterion for surgery.
authors.affiliation: Onze Lieve Vrouwe Gasthuis, afd. Chirurgie, Amsterdam.
authors.forename: Jan
authors.initials: J
authors.lastname: Bosma
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: Anco
authors.initials: A
authors.lastname: Vahl
mesh_terms: D000367:Age Factors; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D002497:Centralized Hospital Services / Q000592:standards*; D006801:Humans; D009426:Netherlands; D018579:Patient Selection; D011788:Quality of Life; D016896:Treatment Outcome