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Kritische Extremitätenischämie bei systemischer Sklerose

Critical limb ischemia in systemic sclerosis

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Zusammenfassung

Vaskuläre Komplikationen sind eine häufige Manifestationsform der systemischen Sklerose (Ssc). Eine kritische Extremitätenischämie mit Gangrän oder Amputation kommt bei diesen Patienten in über 10% der Fälle vor und ist damit eine häufige Notfallsituation. Der vorliegende Beitrag beleuchtet die unterschiedlichen pathogenetischen Mechanismen, die einer kritischen Ischämie zugrunde liegen können, und gibt Hinweise für Diagnostik und Therapie. Neben SSc-typischer Vaskulopathie und peripherer arterieller Verschlusskrankheit finden sich thrombembolische Ereignisse und selten auch eine Vaskulitis als Ursache für eine kritische Ischämie. Diagnostik und Therapie sollten interdisziplinär erfolgen und neben einer Verhinderung weiterer Ischämien und einer möglichen Revaskularisierung auch eine ausreichende Schmerztherapie zum Ziel haben.

Abstract

Vascular complications are common in systemic sclerosis (SSc). Critical limb ischemia leading to gangrene or amputation occurs in more than 10% of these patients and hence is a common emergency. This report highlights the different pathogenetic mechanisms leading to critical ischemic events and provides guidance for the diagnosis and therapy. Apart from SSc-associated vasculopathy and peripheral arterial disease, thromboembolic events and rarely also vasculitis may cause critical limb ischemia. An interdisciplinary approach to the diagnosis and therapy of these lesions is mandatory. Therapy goals are the prevention of further ischemia and, if possible, revascularization as well as optimal pain management.

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Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehung hin: Der Autor ist beratend für die Fa. Actelion tätig.

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  1. Medizinische Klinik mit Schwerpunkt Rheumatologie und klin. Immunologie, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Deutschland

    M.O. Becker & G. Riemekasten

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Becker, M., Riemekasten, G. Kritische Extremitätenischämie bei systemischer Sklerose. Z. Rheumatol. 71, 261–269 (2012). https://doi.org/10.1007/s00393-011-0914-3

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