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Stellenwert der Prostaglandine in der Behandlung der peripheren arteriellen Verschlusskrankheit (PAVK)

Value of prostaglandins for treatment of peripheral arterial occlusive disease (PAOD)

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Zusammenfassung

Ziel der vorliegenden Arbeit ist die Bewertung des klinischen Stellenwerts der Behandlung der PAVK mit Prostaglandinen unter besonderer Berücksichtigung der aktuellen Leitlinienempfehlungen. Bei der Claudicatio intermittens gibt es Hinweise auf die Wirksamkeit von Prostanoiden zur Verbesserung der Gehleistung und Lebensqualität. Für Prostaglandin E1 konnte in einer Metaanalyse eine klinisch relevante Verbesserung der schmerzfreien Gehstrecke belegt werden. Damit einher geht eine Verbesserung der Lebensqualität. Eine Zulassung zu dieser Indikation liegt zurzeit nicht vor.

Bei der kritischen Extremitätenischämie ist aufgrund der hohen Amputationsgefahr vorrangiges Behandlungsziel die endovaskuläre oder operative Revaskularisation. Nur wenn diese Behandlung nicht in Betracht kommt, sind Prostanoide als konservative Therapieoption indiziert. Dabei kann bei etwa 50% der Betroffenen eine Verbesserung der Wundheilung, eine Reduktion der Schmerzen und auch eine Verminderung der Zahl hoher Amputationen erreicht werden. Diese Therapieempfehlungen finden sich in der überwiegenden Anzahl der aktuellen Leitlinien.

Abstract

The aim of this article is to give a review of the clinical relevance of prostaglandins in patients with peripheral arterial occlusive disease with special reference to current guidelines. Intermittent claudication and critical limb ischemia (CLI) are the clinical endpoints of peripheral arterial occlusive disease (PAOD). Although there are limited data on the positive effect of prostaglandin E1 in claudication, there are still no convincing prospective studies to confirm this.

In critical limb ischemia immediate treatment is necessary since tissue perfusion is strongly reduced and major amputation is frequently necessary within the following 6 months, when there is no option for surgical or interventional revascularization. Otherwise conservative measures are necessary, in some cases even additionally to revascularization. Conservative treatment includes local wound care, systemic antibiotic treatment and the intravenous use of prostanoids. As with invasive therapy the most important therapeutic goals are limb salvage, healing of ischemic lesions and preservation of the functional status even beyond the time span of prostanoid therapy. These recommendations for treatment are to be found in the majority of current guidelines.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: H. Lawall hat Vorträge zur PAVK für die Firmen Schwarz Pharma und Bayer Schering Pharma gehalten.

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Authors and Affiliations

  1. Abteilung Angiologie/Diabetologie, SRH-Klinikum Karlsbad-Langensteinbach, Akad. Lehrkrankenhaus der Universität Heidelberg, Guttmannstraße 1, 76307, Karlsbad, Deutschland

    H. Lawall & C. Diehm

  2. Abteilung Gefäßchirurgie, SRH-Klinikum Karlsbad-Langensteinbach, Karlsbad, Deutschland

    R. Huber

  3. Klinik für Gefäßchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    M. Storck

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  1. H. Lawall
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  2. R. Huber
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  3. M. Storck
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  4. C. Diehm
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Correspondence to H. Lawall.

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Lawall, H., Huber, R., Storck, M. et al. Stellenwert der Prostaglandine in der Behandlung der peripheren arteriellen Verschlusskrankheit (PAVK). Gefässchirurgie 13, 164–170 (2008). https://doi.org/10.1007/s00772-008-0594-8

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  • DOI: https://doi.org/10.1007/s00772-008-0594-8

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