title: [Aneurysms of the abdominal aorta and iliac arteries: paradigm shift - operative therapy, if possible endovascular?].
abstract: BACKGROUND
  Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations.
  
  
  OBJECTIVE
  New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs.
  
  
  METHODS
  A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence.
  
  
  RESULTS
  Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary.
  
  
  CONCLUSIONS
  Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance.
authors.affiliation: Klinik für Gefäß- und endovaskuläre Chirurgie, Allgemein- und Viszeralchirurgie Franziskus-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland, ralph.rueckert@franziskus-berlin.de.
authors.forename: R I
authors.initials: RI
authors.lastname: Rückert
authors.forename: U
authors.initials: U
authors.lastname: Hanack
authors.forename: S
authors.initials: S
authors.lastname: Aronés-Gomez
authors.forename: S
authors.initials: S
authors.lastname: Yousefi
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D019990:Perioperative Care; D015996:Survival Rate