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Interventionelle Radiologie als Notfalltherapie

Interventional radiology as emergency therapy

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Zusammenfassung

Klinisches Problem

Sowohl der Fortschritt chirurgischer Techniken als auch die demographische Entwicklung mit der Konsequenz vermehrt multimorbider Patienten fordert und fördert die Radiologie neben einer inzwischen beinahe selbstverständlichen schnellen und präzisen Diagnostik durch minimal-invasive Unterstützung bei der Therapie.

Radiologische Standardverfahren

Die Computertomographie (CT) ist nicht nur bei der Diagnose von Abszessen, aktiven Blutungen oder sonstigen Akutpathologien wichtig, sondern erlaubt auch eine radiologische, minimal-invasive Therapie unter Sichtkontrolle. Für die Blutungskontrolle oder zur perkutanen transhepatischen Cholangiodrainage (PTCD) ist dies mittels digitaler Subtraktionsangiographie (DSA) bzw. Durchleuchtung möglich.

Methodische Innovation und Bewertung

Die Radiologie hat sich bei der Behandlung akuter Notfälle und Komplikationen durch das schonende und meist schnelle minimal-invasive Vorgehen auch in der Therapie etabliert. Vermutlich werden MRT-Interventionen in naher Zukunft zunehmende Bedeutung gewinnen und so das Portfolio ergänzen.

Empfehlung für die Praxis

Die Grundtechniken der interventionellen Radiologie sollten von jedem klinisch im Nachtdienst tätigen Radiologen soweit beherrscht werden, dass zumindest eine medizinisch sichere Überbrückung bis in den Routinebetrieb gewährleistet ist. Das volle Portfolio verlangt u. a. aufgrund der Materialvielfalt und der Seltenheit mancher Krankheitsbilder eine jahrelange Expertise und wird daher speziellen Zentren vorbehalten bleiben.

Abstract

Clinical issue

Both the progress of surgical techniques and the demographic development with increasing numbers of multimorbid patients demand and also encourage radiology in the setting of trauma and acute emergencies. In addition to a fast and precise diagnostics, this also includes image-guided, minimally invasive therapy to control and treat several acute pathologies.

Standard radiological procedures

Computed tomography (CT) is not only important for the diagnosis of abscesses, active bleeding or other acute pathologies, but also allows minimally invasive therapy. While digital subtraction angiography (DSA) guides catheter-based procedures, e.g., to control bleedings or to place percutaneous transhepatic cholangiodrain (PTCD), fluoroscopy allows the 3D-visualization to drain abdominal and thoracic abscesses.

Methodological innovation and evaluation

Radiology has established itself in the treatment of acute emergencies or acute complications through gentle and usually fast minimally invasive procedures. Presumably, MRI interventions will become increasingly important in the near future and, thus, complement the portfolio.

Practical recommendations

Every clinical radiologist who works on night shifts should be able to safely carry out some basic interventional techniques in order to stabilize the patient and at least ensure medically safe bridging to the next routine workday. Due to the diversity of materials and the rarity and difficulty of some procedures, the full portfolio requires years of expertise and will therefore remain restricted to specialized interventional radiologists.

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Authors and Affiliations

  1. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, Marchionistr. 15, 81377, München, Deutschland

    Marco Armbruster, Stefan Wirth & Max Seidensticker

  2. Zentrum für bildgebende Verfahren und interventionelle Therapie, Donau-Isar-Klinikum, Deggendorf, Deutschland

    Stefan Wirth

  3. Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland

    Stefan Wirth

Authors
  1. Marco Armbruster
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  2. Stefan Wirth
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Corresponding author

Correspondence to Marco Armbruster.

Ethics declarations

Interessenkonflikt

M. Armbruster und S. Wirth geben an, dass kein Interessenkonflikt besteht. M. Seidensticker: Lecture fees (Cook Medical, Boston Scientific).

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Armbruster, M., Wirth, S. & Seidensticker, M. Interventionelle Radiologie als Notfalltherapie. Radiologe 60, 258–268 (2020). https://doi.org/10.1007/s00117-019-00637-6

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  • DOI: https://doi.org/10.1007/s00117-019-00637-6

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