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Vaskulitiden

Was muss der Gefäßchirurg dazu wissen?

Vasculitis

What the vascular surgeon must know

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Zusammenfassung

Für die heterogene Erkrankungsgruppe der Vaskulitiden wurde 2012 im Rahmen der Chapel Hill Consensus Conference (CHCC) die 1994 geschaffene Einteilung überarbeitet und erweitert mit dem Ziel der Vereinheitlichung der Nomenklatur. Evidenzbasierte validierte Kriterien zur primären Diagnose der Vaskulitiden existieren derzeit nicht. In der Gefäßchirurgie stellen vor allem die Vaskulitiden mit Befall der großen und mittelgroßen Gefäße wichtige Differenzialdiagnosen dar. Die Riesenzellarteriitis ist mit dem oft gleichzeitig auftretenden Befall extrakranieller Arterien eine der wichtigsten Differenzialdiagnosen der peripheren arteriellen Verschlusskrankheit (pAVK) mit altersabhängig steigender Prävalenz. Bei gastrointestinaler, renaler und koronarer Makroangiopathie ist bei Patienten in mittlerem Lebensalter das Vorliegen der seltenen Polyarteriitis nodosa in Erwägung zu ziehen. An die eng mit Nikotinkonsum assoziierte und oft mit oberflächlichen Thrombophlebitiden einhergehende Thrombangiitis obliterans ist als „Sonderform“ der infrapoplitealen pAVK bei jüngeren Patienten zu denken.

Abstract

Within the framework of the 2012 Chapel Hill Consensus Conference (CHCC) the subdivision of the heterogeneous group of diseases collectively known as vasculitis established in 1994 was revised and expanded with the aim of standardization of the nomenclature. Evidence-based criteria for the primary diagnosis of vasculitis do not currently exist. In vascular surgery the forms of vasculitis affecting medium and large size vessels are important differential diagnoses. Giant cell arteritis which often also simultaneously affects extracranial arteries is one of the most important differential diagnoses of peripheral artery occlusive disease (PAOD) with an age-dependent increase in prevalence. In cases of gastrointestinal, renal and coronary macroangiopathy in middle-aged patients, the presence of polyarteritis nodosa although rare has to be considered. Highly associated with nicotine consumption and often accompanied by superficial thrombophlebitis, thromboangiitis obliterans should be considered as a special form of vasculitis when infrapopliteal occlusive artery disease is present in younger patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Amendt: Vortragstätigkeit für UCB Pharma. M. Sigl und E. Hsu geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Gefäßzentrum Oberrhein, 
Innere Medizin 1 (Angiologie, Kardiologie, Diabetesfolgeerkrankungen), Diakonissenkrankenhaus Mannheim, Speyerer Str. 91–93, 68163, Mannheim, Deutschland

    M. Sigl, E. Hsu & K. Amendt

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  1. M. Sigl
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Correspondence to M. Sigl.

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Sigl, M., Hsu, E. & Amendt, K. Vaskulitiden. Gefässchirurgie 19, 263–277 (2014). https://doi.org/10.1007/s00772-013-1279-5

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