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Notfälle in der Phlebologie

Emergencies in phlebology

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Zusammenfassung

Phlebologische Krankheitsbilder, die eine notfallmäßige Versorgung erforderlich machen, sind die tiefe Beinvenenthrombose, die oberflächliche Venenentzündung und die Varizenblutung. Die tiefe Beinvenenthrombose kann heute mit nichtinvasiven Untersuchungsmethoden wie der Duplexsonographie und dem D-Dimer-Test in den meisten Fällen sicher nachgewiesen werden. Die alleinige klinische Diagnostik ist nicht ausreichend. Die Standardtherapie besteht in der Kompressionsbehandlung und der Antikoagulation mit niedermolekularen Heparinen. Die Thrombophlebitis superficialis ist eine inhomogene Gruppe oberflächlicher Venenentzündungen, die teils thrombotischen und teils entzündlichen Ursprungs sind. Am häufigsten ist die Varikophlebitis oder Varikothrombose, die in bis zu 20% der Fälle eine Mitbeteiligung des tiefen Venensystems aufweist. Neben akuten operativen Eingriffen bei Einwachsen des Thrombus in der Leiste wird in ausgedehnten Fällen zunehmend eine kurzfristige therapeutische Heparinisierung empfohlen. Die Varizenblutung ist eine typische Komplikation des fortgeschrittenen Krampfaderleidens und kann mit Hochlagerung der Extremität, Kompressionstherapie oder im Einzelfall durch Umstechung und Unterbindung oder Sklerotherapie beherrscht werden.

Abstract

Venous diseases which require emergency care include deep venous thrombosis, superficial thrombophlebitis and variceal bleeding. The clinical diagnosis of deep venous thrombosis is often inaccurate, but can be confirmed in most cases with noninvasive tools such as sonography and d-dimer testing. Standard therapy includes compression of the leg and low molecular weight heparin in a therapeutic dosage. Superficial thrombophlebitis includes a variety of disease processes involving superficial veins, some thrombotic and others inflammatory. The most important is varicophlebitis or varicothrombosis, which involves the deep venous system in up to 20% of cases. Along with immediate surgical procedures when the thrombus reaches the deep venous system in the groin, short term therapy with low molecular weight heparin can be used. Variceal bleeding is a typical complication of severe varicose veins. It can be treated by elevating the leg and compression therapy. In addition sclerotherapy or ligation of the bleeding vein can be performed.

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  1. Klinik und Poliklinik für Dermatologie der Rheinischen Friedrich-Wilhelms-Universität, Bonn

    F. Pannier & E. Rabe

  2. Klinik und Poliklinik für Dermatologie der Rheinischen Friedrich-Wilhelms-Universität, Sigmund-Freud-Straße 25, 53105 , Bonn

    F. Pannier

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Pannier, F., Rabe, E. Notfälle in der Phlebologie. Hautarzt 55, 533–542 (2004). https://doi.org/10.1007/s00105-004-0737-0

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