Versorgungsrealität von Aortenerkrankungen in der Schweiz

BACKGROUND: Due to the federally organized healthcare system in Switzerland, aortic interventions are performed in many different hospitals, presumably sometimes with a very small number of cases per institution. The aim of this study was to present the treatment reality of aortic diseases based on the aortic interventions recorded in Switzerland’s vascular registry Swissvasc. METHODS: All interventions on the aorta that were carried out between January 2018 and December 2020 in Switzerland and entered in the Swissvasc registry were included in this overview. Interventions for the treatment of isolated pathologies of the iliac vessels as well as interventions on the ascending aorta and the proximal aortic arch were excluded. RESULTS: Open aortic surgery was performed in 28 hospitals and endovascular aortic repair (EVAR) in 33. Just under half of these hospitals achieved the recommended minimum number of cases for abdominal aortic aneurysms (AAA) of 30 open and endovascular interventions per year, which are currently discussed in the literature. In line with the literature 67% of the elective treatments for AAA were performed by EVAR. Corresponding to the current literature, 11% of the AAA were ruptured in the 3‑year observation period. In contrast to the recommendations of the current guidelines almost 60% of the ruptured AAA were treated by open repair. There was a certain tendency for a spontaneous centralization in the treatment of thoracic aortic pathologies as 87% of the interventions were carried out in only 5 hospitals. CONCLUSION: This study shows that many clinics in Switzerland treat aortic pathologies, some with a very small caseload. Further investigations of the quality of care in the treatment of aortic pathologies are urgently needed.