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Karotisscreening vor chirurgischen Eingriffen

Wann ist eine präoperative Duplexsonographie sinnvoll?

Screening of carotid arteries before surgery

When does preoperative duplex ultrasound make sense?

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Zusammenfassung

Die Karotisstenose ist ein Marker für eine generalisierte Arteriosklerose und geht mit einer erhöhten zerebrovaskulären und kardiovaskulären Morbidität und Mortalität einher. Die Prävalenz steigt bei zunehmendem Alter und männlichem Geschlecht an. Die Karotisstenose ist ein Risikofaktor für perioperative neurologische Komplikationen bei chirurgischen Eingriffen. Bezüglich eines Screenings für das Vorliegen einer asymptomatischen Karotisstenose vor operativen Eingriffen sind die Empfehlungen vor kardiochirurgischen Eingriffen am besten belegt. Sie lassen sich im weitesten Sinne jedoch auch auf allgemeinchirurgische Eingriffe übertragen. Ein generelles Screening wird nicht empfohlen. Dagegen sollte ein präoperatives Screening hinsichtlich einer asymptomatischen Karotisstenose bei Risikopatienten durchgeführt werden, bei denen auch eine therapeutische Konsequenz (Thrombozytenaggregationshemmung, operative Karotisdesobliteration oder Karotisstent) besteht. Dies betrifft alle Patienten mit klinischen Zeichen einer peripheren arteriellen Verschlusskrankheit und Patienten ab dem 65. Lebensjahr mit mindestens einem der Risikofaktoren koronare Herzkrankheit, Rauchen oder Hypercholesterinämie. Eine präoperative Duplexsonographie bei allen Patienten mit auskultatorisch nachgewiesenem Strömungsgeräusch über der Karotisbifurkation erscheint ebenfalls sinnvoll. Durch präoperatives Screening können neurologische Komplikationen aufgrund unerkannter Karotisstenosen reduziert werden.

Abstract

Carotid artery stenosis is a marker for generalized atherosclerosis with high cerebrovascular and cardiovascular morbidity and mortality rates. There is an estimated increase in prevalence of moderate stenosis for older age and male sex. Asymptomatic carotid artery stenosis is a risk factor for perioperative neurological events during general surgery. Planning of effective preoperative screening of populations at risk for asymptomatic carotid artery stenosis is best evaluated for cardiac surgery. General screening is not recommended; however, preoperative screening for asymptomatic carotid artery stenosis should be performed in high-risk patients with options for surgical or interventional treatment. These are patients with clinical signs of peripheral arterial disease and patients over 65 years old with at least one of the risk factors coronary artery disease, smoking and hypercholesterinemia. Preoperative screening in patients with carotid bruits may also be useful. Preoperative carotid artery screening may be beneficial in detecting occult carotid artery stenosis and thereby reducing perioperative neurological events.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Wipper, K. Stoberok, G. Atlihan, A. Kieback, C. Lohrenz, H. Diener und E.S. Debus geben an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    S. Wipper, K. Stoberok, G. Atlihan, A. Kieback, C. Lohrenz, H. Diener &  E.S. Debus

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  1. S. Wipper
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  2. K. Stoberok
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  3. G. Atlihan
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  5. C. Lohrenz
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  6. H. Diener
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  7. E.S. Debus
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Correspondence to E.S. Debus.

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Wipper, S., Stoberok, K., Atlihan, G. et al. Karotisscreening vor chirurgischen Eingriffen. Chirurg 85, 616–621 (2014). https://doi.org/10.1007/s00104-013-2658-x

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  • DOI: https://doi.org/10.1007/s00104-013-2658-x

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