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Postoperative Blutdruckschwankungen nach Karotisendarteriektomie

Implikationen der verschiedenen Rekonstruktionstechniken

Postoperative blood pressure alterations after carotid endarterectomy

Implications of different reconstruction methods

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Zusammenfassung

Hintergrund

Postoperative Blutdruckschwankungen nach Karotisendarteriektomie (CEA) sind bekannte Faktoren für ein erhöhtes Morbiditäts- und Mortalitätsrisiko.

Ziel der Arbeit

Darstellung des Einflusses der zwei etablierten gefäßchirurgischen Rekonstruktionsverfahren, der Eversions-CEA (E-CEA) und der konventionellen CEA mit Patchplastik (K-CEA), sowie der neueren sinuserhaltenden Eversions-CEA (SE-E-CEA) auf die postoperative Hämodynamik unter Berücksichtigung bisheriger wissenschaftlicher Erkenntnisse.

Material und Methoden

Auswertung klinisch-wissenschaftlicher Evidenz aus der PubMed (NLM) -Datenbank zu der jeweiligen Operationstechnik aus dem Zeitraum 1974 bis 2017 unter Ausschluss von Fallberichten.

Ergebnisse

Insgesamt wurden 34 Literaturstellen sowie eine Metaanalyse identifiziert, die sich mit der beschriebenen Thematik wissenschaftlich auseinandersetzen. Die Ergebnisse der Studien sowie der Metaanalyse zeigen, dass die E‑CEA mit einer Beeinträchtigung der lokalen Barorezeptorfunktion und einem erhöhten Bedarf an Vasodilatatoren in der frühen postoperativen Phase vergesellschaftet ist, wohingegen die K‑CEA und SE-E-CEA einen günstigeren Effekt auf den postoperativen Blutdruck auszuüben scheinen.

Schlussfolgerung

Unabhängig von der angewendeten Operationstechnik übt die CEA einen direkten Einfluss auf die Regulation des Blutdrucks aus. Eine engmaschige Überwachung des Blutdrucks sollte zumindest im postoperativen stationären Verlauf stattfinden. Der Stellenwert der SE-E-CEA als Alternative zu der klassischen E‑CEA muss zunächst ausführlicher wissenschaftlich untersucht werden.

Abstract

Background

Postoperative blood pressure alterations after carotid endarterectomy (CEA) are associated with an increased risk of morbidity and mortality.

Objective

To outline the influence of the two commonly used surgical reconstruction techniques, conventional CEA with patch plasty (C-CEA) and eversion CEA (E-CEA), as well as the innovative carotid sinus-preserving eversion CEA (SP-E-CEA) technique on postoperative hemodynamics, taking the current scientific knowledge into consideration.

Methods

Assessment of the current clinical and scientific evidence on each operative technique found in the PubMed (NLM) database ranging from 1974 to 2017, excluding case reports.

Results

A total of 34 relevant papers as well as 1 meta-analysis, which scientifically dealt with the described topic were identified. The results of the studies and the meta-analysis showed that E‑CEA correlates with an impairment of local baroreceptor functions as well as with an elevated need for vasodilators in the early postoperative phase, whereas C‑CEA and SP-E-CEA seem to have a more favorable effect on the postoperative blood pressure.

Conclusion

The CEA technique influences the postoperative blood pressure regulation, irrespective of the operative technique used. Accordingly, close blood pressure monitoring is recommended at least during the postoperative hospital stay. Further studies are mandatory to evaluate the importance of SP-E-CEA as an alternative to the classical E‑CEA.

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Authors and Affiliations

  1. Humanmedizin, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    J. A. Celi de la Torre

  2. Abteilung für Gefäßchirurgie und Endovaskuläre Chirurgie, Kreiskrankenhaus Bergstraße, Heppenheim, Deutschland

    D. A. Skrypnik

  3. Abteilung für vaskuläre Chirurgie, S. V. Ochapovsky regionales Krankenhaus No1, Krasnodar, Russland

    R. A. Vinogradov

  4. Chirurgisches Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    D. Böckler & S. Demirel

Authors
  1. J. A. Celi de la Torre
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  2. D. A. Skrypnik
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  3. R. A. Vinogradov
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  4. D. Böckler
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  5. S. Demirel
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Corresponding author

Correspondence to D. Böckler.

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Interessenkonflikt

J.A. Celi de la Torre, D.A. Skrypnik, R.A. Vinogradov, D. Böckler und S. Demirel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Celi de la Torre, J.A., Skrypnik, D.A., Vinogradov, R.A. et al. Postoperative Blutdruckschwankungen nach Karotisendarteriektomie. Chirurg 89, 123–130 (2018). https://doi.org/10.1007/s00104-017-0502-4

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