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Ein Plädoyer für die Verwendung des inneren Shunts in der Karotischirurgie

Die Veränderungen der Viskoelastizität des Blutes während der Operation

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Zusammenfassung

Nach wie vor wird die Verwendung eines Shunts in der Karotischirurgie kontrovers diskutiert. Eine statistisch signifikante Reduktion perioperativer permanenter neurologischer Ausfälle konnte bei Verwendung eines Shunts nicht nachgewiesen werden. Dennoch können Überlegungen, dass durch die längere Okklusion des orthograden arteriellen Zuflusses Hirnzellen zu Schaden kommen könnten, auch wenn klinisch keine groben neurologischen Ausfälle nachweisbar sind, nicht als unberechtigt abqualifiziert werden.

Während des Klemmens der A. carotis interna treten nachhaltige ungünstige Veränderungen der Fließeigenschaften des Blutes, das aus der ipsilateralen V. jugularis interna gewonnen wird, auf. Unmittelbar nach Einlegen des Shunts bzw. nach Freigabe der Strombahn verbessern oder normalisieren sich diese Parameter. Für diese Prozesse dürften sowohl zelluläre Reaktionen auf die Drosselung der Flussgeschwindigkeit als auch Wasseraustausch zwischen Kapillarbett und Gewebe verantwortlich sein.

Abstract

The routine use of an intraluminal shunt for cerebral protection during carotid endarterectomy has been the topic of much controversy. There is no statistically significant reduction of permanent neurological deficits using an indwelling shunt. However, considerations that cerebral cells may be impaired by occlusion of the supplying blood flow must not be dismissed, even when evidence for neurological deficits is absent.

During cross-clamping of the carotid artery, flow characteristics of blood sampled from the ipsilateral jugular vein are affected adversely. Immediately after installing the shunt or opening the clamp, these changes are reversed or improved. These changes after reduction of the shear velocity might on the one hand be due to cellular reactions of the endothelium and the PMNL and on the other hand to fluid shifts between the capillary vessels and the tissue.

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Authors and Affiliations

  1. Chirurgische Abteilung, Hanuschkrankenhaus, Wien

    M. Hold

  2. Confraternität Privatkrankenanstalt-Josefstadt, Wien

    H. Merrelaar

  3. Chirurgische Abteilung, Hanuschkrankenhaus der Wiener Gebietskrankenkasse, Heinrich-Collin-Str. 30, 1140, Wien, Österreich

    M. Hold

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  1. M. Hold
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  2. H. Merrelaar
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Correspondence to M. Hold.

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Ganz herzlich Herrn Prof. Dr. G.W. Hagmüller zu seinem 60. Geburtstag gewidmet.

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Hold, M., Merrelaar, H. Ein Plädoyer für die Verwendung des inneren Shunts in der Karotischirurgie. Gefässchirurgie 9, 25–30 (2004). https://doi.org/10.1007/s00772-003-0328-x

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