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Diagnostik und Therapie bei Komplikationen

  • Chapter
Dialyseshunts

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Zusammenfassung

Ca. drei Viertel aller Dialyseshunts haben ein „physiologisches“ Steal-Phänomen, was in der Mehrheit ohne Symptome einhergeht. Treten jedoch Symptome auf, spricht man von einem Steal-Syndrom. Ursache der Symptome ist eine periphere Minderdurchblutung. Analog zur Fontaine-Klassifikation bei der peripheren arteriellen Verschlusskrankheit (pAVK) wird der Schweregrad des Steals nach Tordoir in vier Stadien unterteilt (Tabelle 6.1.1) [6, 11]. Es werden extremitätenbedrohende Ischämien in ca. 3,7–5% aller Dialyseshuntpatienten beobachtet [4, 7, 13]. In Abhängigkeit von der Shuntlokalisation steigt das Risiko sogar bis auf 25% an (Unteramfisteln 1—1,8%, Brachialisfisteln 10–25%) [5, 11]. Die Risikofaktoren für eine shuntassoziierte Armischämie sind periphere arterielle Verschlusskrankheit, Diabetes mellitus, Alter, vorangegangene ipsilaterale Shuntanlagen und sowohl High-flow-als auch Low-flow-Fisteln [5].

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Authors and Affiliations

  1. Klinik für Gefässchirurgie, Univ.-Klinikum RWTH Aachen, Pauwelsstraße 30, 52074, Aachen

    Dr. J. Kalder & Dr. S. Langer

  2. Univ.-Klinik für Allgemein-Viszeral- und Gefäßchirurgie, Erlanger Allee 101, 07747, Jena Lobeda-Ost

    Dr. J. Zanow

  3. Abteilung für Allgemeinchirurgie, Univ.-Klinik für Chirurgie, Auenbrugger Platz 29, A-8036, Graz

    Prof. Dr. H. Hauser

  4. Univ. Klinik für Gefäßchirurgie, LKH-Univ. Klinikum Graz, Auenbruggerplatz 29, A-8036, Graz

    Dr. M. Tomka, Prof. Dr. H. Fruhwirth, Prof. Dr. K. Tiesenhausen & Prof. Dr. T. Cohnert

  5. Klinik für Viszeral-und Gefäßchirurgie-Minimal Invasive Chirurgie, St. Hedwig Krnnkenhaus, Große Hamburger Straße 5-11, 10115, Berlin

    Dr. E. P. M. Lorenz, K. E. Lorenz & Dr. med. J. P. Schmalfeldt

  6. Klinik für Allgemein- und Viszeralchirurgie-Minimal, Höhensteig 1, 12526, Berlin-Grünau

    Dr. med. A. K. Wagner

  7. Kreiskrankenhaus Dialysezentrum, Am Wendeberg 2, 36251, Bad Hersfeld

    Dr. P. Thon

  8. Klinik für vaskuläre und endovaskuläre Chirurgie, DRK-Kliniken Köpenick, Salvador-Allende-Straße 2-8, 12559, Berlin

    Dr. M. Naundorf

  9. Hermann-Löns-Weg 24, 69245, Bammental

    Prof. Dr. W. D. Brittinger

  10. Am Fürstenweiher 61, 69118, Heidelberg

    Dr. W. -D. Twittenhoff

  11. Klinik für diagnostische und interventionelle Radiologie, HELIOS Klinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal

    Dr. L. Kamper & Prof. Dr. P. Haage

  12. Kreiskrankenhaus Rastatt Fachbereich Gefäßchirurgie, Klinikum Mittelbaden gGmbH, Engelstraße 39, 76437, Rastatt

    Dr. V. Mickley

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  2. Dr. S. Langer
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  4. Prof. Dr. H. Hauser
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  9. Dr. E. P. M. Lorenz
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  11. K. E. Lorenz
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  16. Dr. W. -D. Twittenhoff
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  17. Dr. L. Kamper
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  18. Prof. Dr. P. Haage
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  19. Dr. V. Mickley
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Editors and Affiliations

  1. Haaner Straße 114, 42719, Solingen

    Wolfgang Hepp

  2. Nephrologisches Zentrum Mettmann, Gartenstraße 8, 40822, Mettmann

    Michael Koch

  3. Schau ins Land 24, 51429, Bergisch Gladbach

    Klaus Konner

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Kalder, J. et al. (2009). Diagnostik und Therapie bei Komplikationen. In: Hepp, W., Koch, M., Konner, K. (eds) Dialyseshunts. Steinkopff. https://doi.org/10.1007/978-3-7985-1572-7_7

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  • DOI: https://doi.org/10.1007/978-3-7985-1572-7_7

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