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Zur chirurgischen Behandlung der peripheren arteriellen Verschlusskrankheit in Deutschland

Pilotprojekt einer Registererhebung

Surgical treatment of peripheral arterial occlusive disease in Germany

Pilot project of a registry

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Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Zielsetzung

In einer Pilotstudie sollte das gefäßchirurgische Krankengut bei peripherer arterieller Verschlusskrankheit (PAVK) stadienabhängig definiert und die wichtigsten Behandlungsverfahren in ihrer Häufigkeit dargestellt werden. Präoperative Risikofaktoren, perioperative Morbidität und Letalität bei endovaskulärem (ER) und offenem (OR) Vorgehen waren zu analysieren.

Methodik

9 Kliniken registrierten prospektiv jeweils über 3 Monate kontinuierlich alle Behandlungen bei PAVK anhand eines bewusst einfach konstruierten Fragebogens, der in der Datenbank SurveyMonkey hinterlegt wurde.

Ergebnisse

Die Dateneingabe dauerte durchschnittlich 5 min pro Patient. Erfasst wurden insgesamt 1030 Patienten, 478 mit intermittierender Claudicatio (IC), 552 mit kritischer Extremitätenischämie (CLI). 121 Patienten (11,7 %) wurden ausschließlich konservativ therapiert, primäre Majoramputationen erfolgten in 2,3 % der Fälle, primäre Minoramputationen in 3,6 %, alle bei CLI. Bei IC wurden 58,9 % aller Eingriffe endovaskulär und 41,1 % offen ausgeführt, bei CLI waren es 47,3 % (ER) bzw. 52,7 % (OR). Das Durchschnittsalter der Patienten lag bei 67,7 (IC) bzw. 72,6 Jahre (CLI). 34 % der IC-Patienten waren Frauen, bei CLI waren es 40 %. Patienten mit IC wiesen einen wesentlich komplikationsärmeren Verlauf als Patienten mit CLI auf. Des Weiteren war die Komplikationsrate stets höher, wenn OR statt ER durchgeführt wurde (Patienten ohne Komplikationen bei IC: ER 94,7 %, OR 79,5 %; bei CLI: ER 80,5 %, OR 60,8 %). Verstorben ist während des stationären Aufenthalts kein Patient mit IC. Bei CLI betrug die Klinikletalität 1,6 % (ER) bzw. 3,9 % (OR).

Folgerung

Postoperative Morbidität und Letalität waren vom PAVK-Stadium abhängig, mit mehr Komplikationen bei CLI verglichen mit IC. Nach ER wurden die besseren Ergebnisse als nach OR erzielt, was allerdings bei fehlender Randomisierung oder Risikostratifizierung noch keine Schlüsse auf die Effektivität beider Verfahren zulässt. Mit dem hier verwendeten Fragebogen konnten mit vergleichsweise geringem Aufwand alle wesentlichen Daten erfasst werden, die in größeren Serien der Literatur zur postoperativen Morbidität und Letalität bei PAVK-Patienten beschrieben werden. Es bietet sich deshalb an, das Pilotprojekt auf eine größere Zahl von Klinken auszudehnen.

Abstract

Objective

The vascular surgery patient population was defined in a pilot study in terms of the stages of peripheral arterial occlusive disease (PAOD), the frequency of treatment methods and the results. Preoperative risk factors, perioperative morbidity and mortality of endovascular (ER) and open revascularization (OR) were analyzed.

Method

A total of nine vascular departments prospectively included all patients treated for POAD in a 3-month period. A simply constructed questionnaire was used that was recorded in the database SurveyMonkey.

Results

Data entry took an average of 5 min per patient. In total, 1030 patients were included, 478 with intermittent claudication (IC) and 552 with critical limb ischemia (CLI). Of the patients 121 (11.7 %) were treated exclusively conservatively, primary major amputations were performed in 2.3 % of cases and primary minor amputations in 3.6 %, all for CLI. The ER amounted to 58.9 % and OR to 41.1 % of all procedures in IC. In patients with CLI, the therapy of choice was ER in 47.3 % and OR in 52.7 %. The mean age of the patients was 67.7 years (IC) and 72.6 years (CLI), respectively, 34 % of IC patients were women and 40 % in the CLI group. Patients with IC had less complications than patients with CLI; furthermore, complications were always higher when OR was performed instead of ER (patients without complications in IC: ER 94.7 %, OR 79.5 % and for CLI: ER 80.5 %, OR 60.8 %). No patient with IC died during hospitalization. In the CLI group, hospital mortality was 1.6 % (ER) and 3.9 % (OR), respectively.

Conclusion

Postoperative morbidity and mortality were dependent on the PAOD stage and there were more complications with CLI compared with IC. Better results were obtained after ER than after OR; however, the absence of randomization and risk stratification does not allow conclusions to be drawn about the effectiveness of both methods. The questionnaire used in this pilot study enabled the collection of all important data described in larger series in the literature on postoperative morbidity and mortality in PAOD patients, with relatively little effort. It is therefore advisable to extend the pilot project to a substantially larger number of hospitals.

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Authors and Affiliations

  1. Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    E.S. Debus

  2. Karlsruhe, Deutschland

    M. Storck

  3. Bremen, Deutschland

    H. Wenk

  4. Frankfurt, Deutschland

    T. Schmitz-Rixen

  5. Berlin, Deutschland

    I. Flessenkämper

  6. Düsseldorf, Deutschland

    A. Oberhuber

  7. Münster, Deutschland

    G. Torsello & A. Stachmann

  8. Stuttgart, Deutschland

    T. Hupp

  9. Nürnberg, Deutschland

    T. Noppeney

  10. DGG, Berlin, Deutschland

    R.T. Grundmann

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  1. E.S. Debus
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Correspondence to E.S. Debus.

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Interessenkonflikt

E.S. Debus, M. Storck, H. Wenk, T. Schmitz-Rixen, I. Flessenkämper, A. Oberhuber, G. Torsello, T. Hupp, T. Noppeney, A. Stachmann und R.T. Grundmann geben an, dass kein Interessenkonflikt besteht.

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Debus, E., Storck, M., Wenk, H. et al. Zur chirurgischen Behandlung der peripheren arteriellen Verschlusskrankheit in Deutschland. Gefässchirurgie 20, 135–145 (2015). https://doi.org/10.1007/s00772-015-0010-0

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