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Farbduplexsonographie bei chronischer und akuter Mesenterialarterienischämie

Wie relevant ist die Farbduplexsonographie für die Diagnostik?

Color duplex sonography in chronic and acute ischemia of the mesenteric artery

Is color duplex sonography relevant for diagnostics?

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Zusammenfassung

Hintergrund und Fragestellung

Es gibt kaum Publikationen zur Bedeutung der Duplexsonographie in der akuten und chronischen mesenterialen Ischämie und die Stenosekriterien sind diskrepant.

Material und Methoden

Kritisches Review der vorliegenden Literatur zwischen 1985 und 2013 zur Validität der Duplexsonographie bei akuter und chronischer mesenterialer Ischämie. Entwicklung eines sonographischen Untersuchungskonzepts mit dem ohne Zeitverzögerung prognoserelevante, akute Mesenterialarterienstammverschlüsse diagnostiziert werden können.

Ergebnisse

Trotz unterschiedlicher Stenosekriterien systolische Spitzengeschwindigkeit (PSV), enddiastolische Geschwindigkeit (EDV) und PSV-Ratio in der Literatur zeigt sich die PSV-Beurteilung als treffsicherste Methode. Bei fehlenden Publikationen mit adäquatem Studiendesign zur akuten mesenterialen Ischämie zeigt ein eigenes duplexsonographisches Konzept zur Evaluierung des Mesenterialarterienstammes im Verlauf mit adäquater Geräteeinstellung sowie der Spektralanalyse am Abgang der A. mesenterica superior eine zeiteffiziente Untersuchungsmethode im prognoserelevanten Frühstadium zur Diagnostik der Mesenterialarterienischämie und zur Vermeidung von ausgedehnten Darmnekrosen. In über 80 % der Fälle kann die Diagnose ohne Zeitverlust gestellt werden. Bei unklaren Befunden muss mittels CT-Angiographie die Diagnose zeitnahe validiert werden.

Schlussfolgerungen

Die Möglichkeiten der Duplexsonographie als liberal einsetzbare Methode (fehlende Nebenwirkungen sowie räumlich ungebunden) in der zeiteffizienten Diagnostik der akuten und chronischen mesenterialen Ischämie werden bisher im klinischen Alltag unterschätzt.

Abstract

Background

Only a few articles have been published on the importance of duplex sonography for acute and chronic ischemia of the mesenteric artery and the criteria for stenosis show discrepancies.

Material and methods

A critical review of the literature between 1985 and 2013 on the validity of duplex sonography for acute and chronic ischemia of the mesenteric artery was carried out. A sonographic investigation concept was developed by which prognosis relevant, acute mesenteric artery stem occlusions can be diagnosed without time delay.

Results

Despite different criteria for stenosis, e.g. peak systolic velocity (PSV), end diastolic velocity (EDV) and the PSV/EDV ratio given in the literature, evaluation of the PSV appears to be the most accurate method. Although there is a lack of publications on acute mesenteric artery ischemia with adequate study design, our own concept of duplex sonography for evaluation over the length of the mesenteric artery stem with optimal instrument adjustment and spectral analysis of the bifurcation of the superior mesenteric artery, is an efficient time-saving method (in the prognosis-relevant early stage) in the diagnosis of ischemia of mesenteric artery and for avoidance of extensive intestinal necrosis. The diagnosis can be made without delay in more than 80 % of cases. When the findings are inconclusive the diagnosis must be rapidly confirmed by computed tomography angiography.

Conclusion

The possibilities of duplex sonography as a universally deployable method (e.g. lack of side effects and spatially flexible) in the time-efficient diagnostics of acute and chronic mesenteric artery ischemia have so far been underestimated in the clinical routine.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Schäberle, L. Leyerer, C. Giebeler, R. Kabiri und P. Richter geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Viszeral-, Gefäß-, Thorax- und Kinderchirurgie, Alb Fils Kliniken, Klinik am Eichert Göppingen, 73035, Göppingen, Deutschland

    W. Schäberle, L. Leyerer, C. Giebeler, R. Kabiri & P. Richter

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  1. W. Schäberle
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  2. L. Leyerer
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  3. C. Giebeler
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Correspondence to W. Schäberle.

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Schäberle, W., Leyerer, L., Giebeler, C. et al. Farbduplexsonographie bei chronischer und akuter Mesenterialarterienischämie. Gefässchirurgie 19, 247–256 (2014). https://doi.org/10.1007/s00772-014-1320-3

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