Zusammenfassung
Diabetiker weisen ein circa 30-fach höheres Amputationsrisiko auf als Nichtdiabetiker, was u. a. auf eine niedrige Revaskularisationsrate zurückzuführen ist. Die Vaskulopathie manifestiert sich i. S. einer Makroangiopathie mit bevorzugtem Befall der Unterschenkeletage. Es ist das Ziel, relevante Durchblutungsstörungen rechtzeitig zu erkennen. Deshalb muss jeder Patient mit diabetischem Fuß auf Anzeichen einer pAVK untersucht werden, und zwar zunächst durch Inspektion, Pulspalpation und Auskultation. Es ist der Knöchel-Arm-Index zu bestimmen.
Bei unplausiblen Befunden muss eine Vorstellung beim Gefäßmediziner erfolgen. Die detaillierte Klärung erfolgt mit spezifischen angiologischen Verfahren: Segmentale Pulsoszillografie, TCpO2-Messung, farbcodierte Duplexsonografie, digitale Subtraktionsangiografie, MR-Angiografie.
Besteht eine relevante Druchblutungsstörung ist eine Revaskularisation anzustreben. Gleichzeitig sollte eine gezielte medikamentöse Begleittherapie erfolgen.
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Kuhlencordt, P. (2022). Die angiologische Diagnostik und Therapie beim diabetischen Fuß. In: Kessler, S. (eds) Die interdisziplinäre Behandlung des diabetischen Fußes. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63119-5_2
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