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Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten

Evidence-based recommendations on primary diagnostics of peripheral arterial occlusive disease in geriatric patients

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Zusammenfassung

Die Prävalenz der peripheren arteriellen Verschlusskrankheit (PAVK) im Alter ist hoch, die klinische Manifestation oft untypisch und die Begleit- und Folgemorbidität erheblich. Dies begründet das Erfordernis einer Basisdiagnostik bei dieser Patientengruppe. Gestützt auf eine Literaturrecherche wurden evidenzbasierte Empfehlungen formuliert. Obligater Bestandteil der Primärdiagnostik sind Pulspalpation und Anamneseerhebung auch dann, wenn typische Beschwerden fehlen. Bei pathologischen und nicht verwertbaren Befunden sollte als nächster Schritt eine Doppler-Knöcheldruckmessung durchgeführt werden. Folgende Faktoren bestimmen das weitere Vorgehen: das Vorliegen von Wunden an dem durchblutungsgestörten Bein, insbesondere im Fuß- und Unterschenkelbereich, das Ausmaß PAVK-bedingter Beschwerden, schließlich geplante operative Eingriffe am betroffenen Bein aus anderen Gründen.

Abstract

The prevalence of peripheral arterial occlusive disease (PAOD) is high in elderly patients and its clinical manifestation is often atypical. Comorbidity and morbidity as a consequence of PAOD are significant. Therefore, standardized primary diagnostics are required among geriatric patients. Drawn from a search of the literature, evidence-based recommendations are provided. Pulse palpation and the evaluation of a patient’s medical history are obligatory components of primary diagnostics, even in the absence of typical symptoms. In the case of pathological and ambiguous findings, measuring Doppler ankle pressures is suggested as the next diagnostic step. Further measures depend on the following factors: the presence of lesions on the leg with disturbed blood flow, predominantly in the foot and lower leg areas, degree of PAOD-related ailments, and, finally, intended surgery of the affected leg for other medical reasons.

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Literatur

  1. Al Zahrani HA, Al Bar HM, Bagnassi A, Abdulaal AA (1997) The distribution of peripheral arterial disease in a defined population of elderly high-risk Saudi patients. Int Angiol 16(2):123–128

    Google Scholar 

  2. Barzilay JI, Spiekerman CF, Kuller LH et al (2001) Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diabetes care 24(7):1233–1239

    Article  CAS  PubMed  Google Scholar 

  3. Bickel H, Gradinger R, Kochs E et al (2004) Incidence and risk factors of delirium after hip surgery. Psychiatr Prax 31(7):360–365

    Article  PubMed  Google Scholar 

  4. Bird CE, Criqui MH, Fronek A et al (1999) Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing. Vasc Med 4(1):15–21

    Article  CAS  PubMed  Google Scholar 

  5. Brearley S, Shearman CP, Simms MH (1992) Peripheral pulse palpation: an unreliable sign. Ann R Coll Surg Engl 74(3):169–171

    CAS  PubMed  Google Scholar 

  6. Christensen JH, Freundlich M, Jacobsen BA, Falstie-Jensen N (1999) Clinical relevance of pedal oulse palpation in patients suspected of peripheral arterial insufficiency. J Intern Med 226(2):95–99

    Google Scholar 

  7. Coni N, Tennison B, Troup M (1992) Prevalence of lower extremity arterial disease among elderly people in the community. Br J Pract 42(357):149–152

    CAS  Google Scholar 

  8. Criqui MH, Coughlin SS, Fronek A (1985) Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study. Circulation 72(4):768–773

    CAS  PubMed  Google Scholar 

  9. Criqui MH, Fronek A, Klauber MR et al (1985) The sensitivity, specificity and predictive value of traditional clinical evaluation of peripheral arterial disease: results from non-invasive testing in a defined population. Circulation 71:516–522

    CAS  PubMed  Google Scholar 

  10. Criqui MH, Fronek A, Klauber MR et al (1985) The prevalence of peripheral arterial disease in a defined population. Circulation 71(3):510–516

    CAS  PubMed  Google Scholar 

  11. Deutsche Gesellschaft für Angiologie, Gesellschaft für Gefäßmedizin (2001) Leitlinien zur Diagnostik und Therapie der arteriellen Verschlusskrankheit der Becken-Beinarterien. Vasa 30 (Suppl 57)

  12. Diamantopoulos EJ, Hild R (1972) Über die Treffsicherheit der Oszillographie und der Pulspalpation auf Grund angiographischer Befunde bei arterieller Verschlusskrankheit. Dtsch Med J 23(5):368–370

    CAS  PubMed  Google Scholar 

  13. Diehm C, Schuster A, Allenberg JR et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 172(1):95–105

    Article  CAS  PubMed  Google Scholar 

  14. Fowkes FG, Housley E, Cawood EH et al (1991) Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 20:384–392

    Article  CAS  PubMed  Google Scholar 

  15. Friedman SA (1976) Common manifestations of degenerative arterial disease. Med Clin North Am 60(6):1079–1092

    CAS  PubMed  Google Scholar 

  16. Hänsgen K, Podhaisky H, Preuß EG (1989) Pulstastbefund und nichtinvasiv gemessene Blutdruckwerte der A. tib. post. bei arterieller Verschlusskrankheit. Z Ges Inn Med 44(11):332–334

    PubMed  Google Scholar 

  17. Hafner J, Schaad I, Schneider E et al (2000) Leg ulcers in peripheral arterial disease (arterial leg ulcers): impaired wound healing above the treshold of chronic critical limb ischemia. J Am Acad Dermatol 43(6):1001–1008

    Article  CAS  PubMed  Google Scholar 

  18. Hirsch AT, Criqui MH, Treat-Jacobson et al (2001) Peripheral arterial disease detection, awareness and treatment in primary care. JAMA 286(11):1317–1324

    Article  CAS  PubMed  Google Scholar 

  19. Holstein P, Lassen NA (1980) Healing of ulcers on the feet correlated with distal blood presssure measurements in occlusive arterial disease. Acta Orthop Scand 51(6):995–1006

    Article  CAS  PubMed  Google Scholar 

  20. Hooi JD, Kester AD, Stoffers HE et al (2001) Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study. Am J Epidemiol 153(7):666–672

    Article  CAS  PubMed  Google Scholar 

  21. Hooi JD, Stoffers HE, Kester AD et al (2002) Peripheral arterial occlusive disease: prognostic value of signs, symptoms and the ankle-brachial pressure index. Med Decis Making 22(2):99–107

    PubMed  Google Scholar 

  22. Kannel WB, McGee DL (1985) Update on some epidemiological features of intermittent claudication: the Framingham study. J Am Geriatr Soc 33(1):13–18

    CAS  PubMed  Google Scholar 

  23. Katzel LI, Sorkin J, Bradham D, Gardner AW (2000) Comorbidities and the entry of patients with peripheral arterial disease into an exercise rehabilitation program. J Cardiopulm Rehabil 20(3):165–171

    Article  CAS  PubMed  Google Scholar 

  24. Kay TW, Martin FI (1986) Heel ulcers in patients with long-standing diabetes who wear antiembolism stockings. Med J Aust 145(6):290–291

    CAS  PubMed  Google Scholar 

  25. Lange S, Diehm C, Darius H et al (2004) High prevalence of peripheral arterial disease and low treatment rates in elderly primary care patients with diabetes. Exp Clin Endocrinol Diabetes 112(10):566–573

    Article  CAS  PubMed  Google Scholar 

  26. Leng GC, Fowkes FGR, Lee AJ et al (1996) Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ 313:1440–1443

    CAS  PubMed  Google Scholar 

  27. Lundin M, Wiksten JP, Perakyla T et al (1999) Distal pulse palpation: is it reliable? World J Surg 23(3):252–255

    Article  CAS  PubMed  Google Scholar 

  28. Martin M, Tenbült L (1985) Result of treatment in 118 foot necroses in relation to ankle blood pressure and diabetes. A one-year retrospective study of 108 patients. Dtsch Med Wochenschr 110(25):989–993

    Article  CAS  PubMed  Google Scholar 

  29. Matzke S, Lepantalo M (2001) Claudication does not always precede critical leg ischemia. Vasc Med 6(2):77–80

    CAS  PubMed  Google Scholar 

  30. McDermott MM, Criqui MH, Greenland P et al (2004) Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance. J Vasc Surg 39(3):523–530

    Article  PubMed  Google Scholar 

  31. McDermott MM, Fried L, Simonsick E et al (2000) Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women’s health and aging study. Circulation 101(9):1007–1012

    CAS  PubMed  Google Scholar 

  32. McGee SR, BoykoEJ (1998) Physical examination and chronic lower-extremity ischemia: a critical review. Arch Intern Med 158(12):1357–1364

    Article  CAS  PubMed  Google Scholar 

  33. Meijer WT, Grobbee DE, Hunink MG et al (2000) Determinants of peripheral arterial disease in the elderly: The Rotterdam study. Arch Intern Med 160(19):2934–2938

    Article  CAS  PubMed  Google Scholar 

  34. Moffatt C, O’Hare L (1995) Ankle pulses are not sufficient to detect impaired arterial circulation in patients with leg ulcers. J Wound Care 4(3):134–138

    CAS  PubMed  Google Scholar 

  35. Moucka J, Jäger K (1990) Rationelle Abklärung bei peripherer arterieller Verschlusskrankheit. Schweiz Rundsch Med Prax 79(50):1553–1560

    CAS  PubMed  Google Scholar 

  36. Muller-Bühl U, Engeser P, Klimm HD, Wiesemann A (2003) Quality of life and objective disease criteria in patients with intermittent claudication in general practice. Fam Pract 20(1):36–40

    Article  PubMed  Google Scholar 

  37. Newman AB, Siscovick DS, Manolio TA et al (1993) Ankle-arm-index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Health Study (CHS) Collaborative Research Group. Circulation 88(3):837–845

    CAS  PubMed  Google Scholar 

  38. Newman AB, Sutton-Tyrell K, Vogt MT, Kuller LH (1993) Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. JAMA 270(4):497–498

    Article  Google Scholar 

  39. Newman AB, Tyrrell KS, Kuller LH (1997) Mortality over four years in SHEP participants with a low ankle-arm index. J Am Geriatr Soc 45(12):1472–1478

    CAS  PubMed  Google Scholar 

  40. New Zealand Guidelines Group (1999) Care of people with chronic leg ulcers. An evidence based guideline. www.nzgg.org.nz/guidelines/0008/ACF672.pdf

  41. Norton D (1996) Calculating the risk: reflections on the Norton scale. Adv Wound Care 9:38–43

    CAS  PubMed  Google Scholar 

  42. Ogren M, Hedblad B, Jungquist G et al (1993) Low ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study „Men born in 1914“, Malmo, Sweden. Eur J Vasc Surg 7(5):500–506

    Article  CAS  PubMed  Google Scholar 

  43. Paris BE, Libow LS, Halperin JL, Mulvihill MN (1988) The prevalence and one-year outcome of limb arterial obstructive disease in a nursing home population. J Am Geriatr Soc 36(7):607–612

    CAS  PubMed  Google Scholar 

  44. Philipps B, Sackett D, Badenoch D et al (2001) Centre of Evidence Based Medicine Oxford http://cebm.net/index.aspx?o=1025

  45. Ploenes CH, Heimig TH, Spamer C et al (2005) Abnormal lower limb pulses in geriatric in-patients. Euro J Ger 7(2):113–116

    Google Scholar 

  46. Resnick HE, Lindsay RS, Mc Dermott MM et al (2004) Relationship of high and low ankle brachial index to all-cause and cardiovascular disease morbidity. The strong heart study. Circulation 109:733–739

    Article  PubMed  Google Scholar 

  47. Royal college of nursing and national institute for health and clinical excellence (2005) The management of pressure ulcers in primary and secondary care. Final version www.nice.org.uk/nicemedia/pdf/PressureUlcers_Finalscope.pdf

  48. Sasajima Y, Sasajima T, Uchida H et al (2000) Postoperative delirium in patients with chronic lower limb ischaemia: what are the specific markers? Eur J Vasc Endovasc Surg 20(2):32–37

    Article  Google Scholar 

  49. Scottish Intercollegiate Guidelines Network (1998) The care of patients with cronic leg ulcer. SIGN Publication Number 26

  50. (n a) (1992) Second European Consensus Document. Eur J Vasc Surg 6 (Suppl A):1–32

  51. Skau T, Jonsson B (1993) Prevalence of symptomatic leg ischemia in a Swedish community – an epidemiological study. Eur J Vasc Surg 7(4):432–437

    Article  CAS  PubMed  Google Scholar 

  52. Stoffers HE, Kester AD, Kaiser V et al (1997) Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice: a multivariate approach. Med Decis Making 17:61–70

    Article  CAS  PubMed  Google Scholar 

  53. Stoffers HE, Rinkens PE, Kester AD et al (1996) The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease. Int J Epidemiol 25(2):282–290

    Article  CAS  PubMed  Google Scholar 

  54. TASC II Inter-Society Consensus on Peripheral Arterial Disease(TASC) (2007). Eur J Vasc Endovasc Surg 33 (Suppl 1):S 24–S 25

    Google Scholar 

  55. Treiman GS, Oderich GS, Ashrafi A, Schneider PA (2000) Management of ischemic heel ulceration and gangrene: an evaluation of factors associated with successful healing. J Vasc Surg 31(6):1110–1118

    CAS  PubMed  Google Scholar 

  56. Vogt MT, Cauley JA, Kuller LH, Huller SB (1993) Prevalence and correlates of lower extremity arterial disease in elderly women. Am J Epidemiol 137(5):559–568

    CAS  PubMed  Google Scholar 

  57. Vogt MT, McKenna M, Anderson SJ et al (1993) The relationship between ankle-arm index and mortality in older men und women. J Am Geriatr Soc 41(5):523–530

    CAS  PubMed  Google Scholar 

  58. Wound Ostomy and Continence Nurses Society (WOCN) (2002) Guideline for management of wounds in patients with lower-extremity arterial disease. WOCN clinical guideline series; no. 1

  59. Yeh ST, Morton DJ, Barrett-Connor E (2000) Lower extremity arterial disease in older women: the Rancho Bernardo Study. J Womens Health Gend Based Med 9(4):373–380

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Angiologie, Dominikus-Krankenhaus, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Deutschland

    C. Ploenes

  2. Abteilung für Gefäßchirurgie und Angiologie, St. Bonifatius-Hospital, Lingen, Deutschland

    H. Görtz

  3. Geriatrische Klinik, Krankenhaus St. Barbara Attendorn, Attendorn, Deutschland

    T. Heimig

  4. Klinik für Innere Medizin und Geriatrie, Diakonissen-Krankenhaus, Dessau, Deutschland

    M. Meisel

  5. Geriatrische Rehabilitationsklinik Dresden-Löbtau, Dresden, Deutschland

    C. Naumann

  6. HELIOS Geriatriezentrum Zwenkau, Zwenkau, Deutschland

    R. Sultzer

  7. Arbeitsgruppe Gefäßerkrankungen der Deutschen Gesellschaft für Geriatrie, xxxxxx, Deutschland

    C. Ploenes, H. Görtz, T. Heimig, M. Meisel, C. Naumann & R. Sultzer

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  1. C. Ploenes
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  2. H. Görtz
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Correspondence to C. Ploenes.

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Ploenes, C., Görtz, H., Heimig, T. et al. Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten. Z Gerontol Geriat 43, 165–169 (2010). https://doi.org/10.1007/s00391-009-0051-7

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  • DOI: https://doi.org/10.1007/s00391-009-0051-7

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