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Die Bedeutung der perioperativen medikamentösen Therapie für das Ergebnis gefäßchirurgischer Operationen

The impact of perioperative medical therapy on vascular surgery outcome

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Zusammenfassung

Kardiopulmonale Komplikationen nach vaskulären Eingriffen sind Folge von patientenspezifischen Faktoren, der Operation und der Umstände, unter welchen die Operation durchgeführt wurde. Myokardinfarkt und kardialer Tod sind die Hauptursachen der perioperativen Mortalität von Patienten, die einer vaskulären Operation unterzogen werden. Die perioperative medikamentöse Therapie ist ein Bestandteil der Risikoreduzierung für diese Patienten. Dieser Artikel beschreibt die Bedeutung von β-Blockern, Statinen und anderen Medikamentengruppen für die Senkung der perioperativen Morbidität. Obgleich es weit verbreitete Ansicht ist, dass eine perioperative β-Blockade ein wirksamer Schutz vor kardialen Ereignissen bei Hochrisikopatienten darstellt, fehlen Daten zur praktischen Anwendung und zur Art und Dauer dieser Medikation. Weitere kardioprotektive Substanzen sind Statine, die neben dem lipidsenkenden Effekt auch zur Stabilisierung atheromatöser Plaqueformationen beitragen. Die Wirkungen von α2-Agonisten und Thrombozytenaggregationshemmern werden ebenfalls diskutiert.

Abstract

Cardiac complications after vascular surgery are specific to the patient, the surgery itself, and the circumstances under which surgery was performed. Myocardial infarction and congestive heart failure are the major causes of perioperative morbidity and mortality in patients with cardiac comorbidities undergoing major vascular surgery. The perioperative medical treatment of patients presenting with cardiovascular risk factors is aimed at reducing the incidence of postoperative complications—in an increasing number of patients, due to increasing life expectancy. This paper discusses the impact of beta blockers, statins, and other medical therapy on the prevention of perioperative morbidity. Although it is generally accepted that preoperative treatment with beta blockers constitutes effective prevention of postoperative cardiac complications in high-risk patients, data are needed in order to derive guiding principles addressing the type and duration of beta blocker therapy. Statins are another group of cardioprotective medications that offer, besides lipid-lowering effects, stabilization of atherosclerotic plaque. The effects of alpha-2 agonists and antiplatelet therapy are also discussed.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie – vaskuläre und endovaskuläre Chirurgie –, HELIOS Klinikum Krefeld, Lutherplatz. 40, 47805, Krefeld, Deutschland

    T. Nowak

  2. Klinik für Gefäßchirurgie und Nierentransplantation, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    K.M. Balzer

  3. Klinik für Viszeral-, Allgemein- und Gefäßchirurgie, Katholisches Krankenhaus Dortmund-West, Dortmund, Deutschland

    H. Böhner

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  1. T. Nowak
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  3. H. Böhner
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Correspondence to T. Nowak.

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Nowak, T., Balzer, K. & Böhner, H. Die Bedeutung der perioperativen medikamentösen Therapie für das Ergebnis gefäßchirurgischer Operationen. Gefässchirurgie 14, 301–307 (2009). https://doi.org/10.1007/s00772-008-0628-2

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