Zusammenfassung
In Deutschland steigt die Zahl der Diabetespatienten und beträgt aktuell über 6 Mio. Im Rahmen der neuropathischen und angiopathischen Spätfolgen steigt auch die Zahl der Patienten, die an einem diabetischen Fußsyndrom erkranken, kontinuierlich an. Jährlich entwickeln mehr als 150.000 Diabetespatienten ein Fußulkus, welches in der Regel verzögert heilt und häufig in ein chronisches Wundstadium übergeht. Trotz intensiver Bemühungen der einzelnen medizinischen Fachgebiete um Prävention, frühzeitige Diagnostik und adäquate Wundbehandlung werden jährlich über 20.000 Major-Amputationen bei Diabetespatienten in Deutschland durchgeführt. Ein großer Teil dieser Amputationen wäre vermeidbar, wenn im Rahmen eines multidisziplinären Therapiekonzeptes rechtzeitig an eine Verbesserung der arteriellen Durchblutung gedacht würde. Bei konsequenter Therapie des diabetischen Fußsyndroms in interdisziplinären Zentren mit Ausschöpfung aller Möglichkeiten einer arteriellen Revaskularisation könnten die Amputationsraten um bis zu 80% gesenkt werden.
In der vorliegenden Arbeit werden Pathogenese, Diagnostik und Therapie des diabetischen Fußsyndroms aus gefäßchirurgischer Sicht aufgezeigt. Insbesondere werden endovaskuläre, offen-chirurgische und kombiniert endovaskulär-gefäßchirurgische Methoden (Hybrideingriffe) der arteriellen Revaskularisation beschrieben.
Abstract
The number of diabetic patients in Germany is rising, currently totalling more than 6 million. Due to neuropathic and angiopathic long-term damage the number of patients with “diabetic foot syndrome” has been increasing dramatically in recent years, and continues to do so. Every year, more than 150,000 diabetics develop a foot ulcer that often heals slowly and therefore becomes a chronic wound. Despite intensive preventive efforts on the part of the individual medical specialties, early diagnosis and adequate therapy, there are more than 20,000 diabetics undergoing major limb amputation in Germany every year. A large number of these amputations could be avoided if an improvement of arterial perfusion were to be considered earlier in the course of a multidisciplinary treatment approach. With consistent therapy in interdisciplinary centres, and by applying all methods of arterial revascularization, the amputation rate in patients with diabetic foot problems could be reduced by 80%.
This article describes the pathogenesis, diagnostics and therapy of the diabetic foot syndrome from a vascular surgical point of view. The importance of endovascular, vascular-surgical as well as combined (hybrid) procedures of revascularization is emphasized.
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Rümenapf, G., Morbach, S., Amendt, K. et al. Gefäßchirurgische Therapie des diabetischen Fußsyndroms. Diabetologe 5, 91–101 (2009). https://doi.org/10.1007/s11428-008-0346-0
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DOI: https://doi.org/10.1007/s11428-008-0346-0