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Offene Therapie der Karotisstenose durch Endarteriektomie

Open therapy of carotid stenosis by endarterectomy

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Zusammenfassung

Die Karotisdesobliteration ist ein gefäßchirurgischer Routineeingriff. In die Indikationsstellung fließt als wesentliche Einflussgröße neben der klinischen Symptomatik und dem Stenosegrad auch die operative Komplikationsrate ein. Sie orientiert sich an der Schlaganfallhäufigkeit und der postoperativen Mortalität und sollte bei symptomatischen >70%igen Stenosen die 6%-Marke nicht überschreiten.

Der konventionellen Karotisdesobliteration mittels Längsarteriotomie steht die Eversionsendarteriektomie nach schräger Transsektion gegenüber. Der Arteriotomieverschluss nach erstgenanntem Verfahren kann mittels Direktnaht oder Patchplastik erfolgen. Es existieren verschiedene Methoden der zerebralen Protektion, von denen die Shuntplatzierung die chirurgische Technik unmittelbar betrifft. In der vorliegenden Arbeit werden die verschiedenen Techniken der Karotisdesobliteration einander gegenübergestellt und kritisch diskutiert.

Abstract

Carotid endarterectomy is a routine procedure in vascular surgery. Besides clinical symptoms and the degree of stenosis, indication for surgery is influenced by the perioperative complication rate. This depends on stroke and the mortality rate and should not exceed 6% in symptomatic, high-grade stenosis, according to the Stroke Council of the American Heart Association. Techniques of carotid disobliteration include the conventional open thrombendarterectomy by means of a longitudinal arteriotomy and the eversion technique. In the former, closure by direct suture or patch plasty are possible. Different methods for cerebral protection during the clamping time exist, of which shunt protection is the most common. The various operative techniques are described and critically discussed.

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  1. Abteilung für Allgemein-, Gefäß- und Visceralchirurgie, GefäßCentrum Hamburg-Harburg, Allgemeines Krankenhaus Harburg, Hamburg

    E. S. Debus, A. Larena & Ch. Wintzer

  2. Abteilung für Allgemein-, Gefäß- und Visceralchirurgie, Chirurgische Klinik, Allgemeines Krankenhaus Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg

    E. S. Debus

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  1. E. S. Debus
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  2. A. Larena
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  3. Ch. Wintzer
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Correspondence to E. S. Debus.

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Debus, E.S., Larena, A. & Wintzer, C. Offene Therapie der Karotisstenose durch Endarteriektomie. Chirurg 75, 658–666 (2004). https://doi.org/10.1007/s00104-004-0872-2

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