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Akute Extremitätenischämie durch paradoxe Embolisation

Ein unterschätztes Problem

Acute ischemia of the extremities caused by paradoxical embolism

An underestimated problem

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Zusammenfassung

Die paradoxe Embolie bei offenem Foramen ovale wurden bereits im 19. Jahrhundert beschrieben und ist heute als mögliche Schlaganfallursache v. a. bei jüngeren Menschen allgemein akzeptiert. Demgegenüber werden paradoxe Embolien als Ursache akuter Extremitätenischämien noch immer kaum in Erwägung gezogen.

Im eigenen chirurgisch behandelten Krankengut fanden wir bei konsequenter Durchführung transösophagealer Echokardiographien einen Anteil von über 10% paradoxer peripherer Embolien. Es drängt sich daher der Eindruck auf, dass die wahre Inzidenz paradoxer peripherer Embolien deutlich höher liegt als bisher angenommen. Die nachfolgende Übersichtsarbeit beschäftigt sich ausführlich mit der Pathophysiologie, Diagnostik und Rezidivprophylaxe der paradoxen Embolie.

Abstract

Paradoxical embolism was first described in the nineteenth century and is now commonly accepted as a potential cause of cerebral ischemia especially in younger people. In contrast to stroke, paradoxical embolization is still rarely considered in acute limb ischemia. Using transesophageal echocardiography in all cases of peripheral emboli of unknown origin, we found that more than 10% of our surgically treated cases were due to patent foramen ovale (PFO). Paradoxical embolization through PFO might thus still be widely underestimated. We therefore report extensively on the pathophysiology, diagnostic procedures, and therapeutic options to prevent recurrences.

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Danksagung

Die Autoren danken Frau Gudrun Hartenhauer für ihre Hilfe bei der Erstellung des Manuskripts.

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Authors and Affiliations

  1. DRK—Kliniken Köpenick, Berlin, Klinik für Physikalische und Rehabilitative Medizin / Schwerpunkt Angiologie

    P. Klein-Weigel

  2. Medizinische Universität, Innsbruck, Klinische Abteilung für Gefäßchirurgie

    B. Hugl, L. Posch, A. Greiner, B. Neuhauser & G. Fraedrich

  3. DRK-Kliniken Köpenick, Klinik für Physikalische und Rehabilitaive Medizin/Angiologie, Salvador-Allende-Str. 2–8, 12559, Berlin

    P. Klein-Weigel

Authors
  1. P. Klein-Weigel
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  2. B. Hugl
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  3. L. Posch
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  4. A. Greiner
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  5. B. Neuhauser
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Correspondence to P. Klein-Weigel.

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Klein-Weigel, P., Hugl, B., Posch, L. et al. Akute Extremitätenischämie durch paradoxe Embolisation. Gefässchirurgie 10, 109–113 (2005). https://doi.org/10.1007/s00772-004-0375-y

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  • DOI: https://doi.org/10.1007/s00772-004-0375-y

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