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Kritische Extremitätenischämie

Critical limb ischemia

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Zusammenfassung

Die Extremitätenischämie lässt sich in eine akute und eine chronische Form unterteilen. Die Differenzialdiagnostik der akuten Ischämie muss umgehend erfolgen, eine sofortige Revaskularisation ist in den meisten Fällen notwendig. Die chronische kritische Extremitätenischämie ist die schwerste Form der peripheren arteriellen Verschlusskrankheit (PAVK). Sie ist gekennzeichnet durch Ruheschmerzen beziehungsweise Nekrosen oder Gangrän. Wesentliche Risikofaktoren bestehen im Nikotinabusus, der arteriellen Hypertonie, dem Diabetes mellitus und der Fettstoffwechselstörung. Patienten mit einer PAVK haben ein deutlich erhöhtes Risiko für kardiovaskuläre Komplikationen. Daher sollte bei diesen Patienten eine Sekundärprophylaxe mit einem Thrombozytenfunktionshemmer erfolgen. Neben der klinischen Untersuchung und der Erhebung des Knöchel-Arm-Indexes ist eine ergänzende Bildgebung obligat. Die digitale Subtraktionsangiographie ist hierbei der Goldstandard. Bei der Therapie stehen prinzipiell operative sowie interventionelle Verfahren zur Verfügung. Die Entscheidung, welche Therapie durchgeführt werden sollte, muss individuell erfolgen. Zur Orientierung dient eine interdisziplinäre internationale Leitlinie (TASC-Klassifikation).

Abstract

Critical limb ischemia can be divided into acute and chronic forms. All patients suspected of the acute form should be evaluated immediately, as urgent revascularization is usually necessary. Chronic critical limb ischemia is the most complicated type of peripheral artery disease (PAD). Typical for it are pain at rest and necrosis or gangrene. The most important known risk factors are nicotine, hypertension, diabetes, and hyperlipoproteinemia. Patients suffering from PAD run a significantly higher risk of cardiovascular or cerebrovascular events and therefore should be on permanent antithrombotic therapy as secondary prophylaxis. Besides clinical examination and determination of the ankle/brachial index, complementary imaging is mandatory. Here angiography is the gold standard. For therapy surgical and other interventional procedures are available. The decision on individual therapy follows an interdisciplinary approach based on an international consensus (TASC classification).

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  1. Gefäßchirurgie, Chirurgische Klinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    C. Denzel & W. Lang

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  1. C. Denzel
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  2. W. Lang
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Correspondence to C. Denzel.

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Denzel, C., Lang , W. Kritische Extremitätenischämie. Chirurg 79, 495–508 (2008). https://doi.org/10.1007/s00104-008-1530-x

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