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Gefäßchirurgie im Alter

Vascular surgery in the elderly

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Zusammenfassung

Die Prävalenz von Gefäßerkrankungen nimmt mit steigendem Lebensalter zu. Für den chronologisch alten, biologisch „fitten“ Patienten sind gefäßchirurgische Eingriffe nicht zwangsläufig mit höherer Morbidität und Mortalität als bei jüngeren Menschen verbunden. Hauptprobleme sind ungenügende oder fehlende Diagnostik, die eine rechtzeitige Therapie verhindern und eine erhöhte Letalität bei dann oft erforderlichen Notfalloperationen zur Folge haben. Neuere Techniken, v. a. die endovaskulären Verfahren erhöhen die Chancen zur Durchführung von Gefäßoperationen unabhängig vom Alter des Patienten. Eine sorgfältige Patientenselektion als Ergebnis einer Risiko-Nutzen-Analyse ist notwendig. Therapieziel beim alten Menschen ist die Erhaltung der Selbstständigkeit und Lebensqualität. Eine Ausnahme stellt die chirurgische Therapie beim rupturierten Aneurysma dar. Die Indikationsstellung beim alten Menschen ist und bleibt eine Individualentscheidung. Der Faktor „Alter“ stellt allein weder eine Limitierung noch eine Kontraindikation in der Karotis-, Aneurysma- oder Bypasschirurgie dar. Hohes Alter ist keine Krankheit, sondern ein in der Chirurgie zu berücksichtigender Faktor.

Abstract

The prevalence of vascular disease among the elderly population is high (~20%). The morbidity and mortality of many vascular operations show no differences between the fit elderly and younger patients. A major problem is that the elderly are often not diagnosed and treated early enough to prevent emergency operations, which carry a much higher mortality. Many new surgical techniques, especially endovascular interventions, have made vascular surgery less invasive. These advances have increased the potential of life saving and prolonging vascular surgery that can be offered to all patients regardless of age. Risk-benefit analysis, especially in elderly patients, is a cornerstone of proper patient selection. The main goal of vascular surgery in the elderly is preservation of quality of life and independence. Surgery of a ruptured aneurysm is a life saving exception. Indications for treatment in the elderly remains an individual decision making process. Advanced age should not be considered as a limitation or contraindication for carotid, aneurysm and bypass surgery. Age is not a disease, it is just a chapter of life.

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Literatur

  1. Pressemitteilung des Statistischen Bundesamtes vom 6. Juni 2003, http://www.destatis.de/presse/deutsch/pm2003/p2300022.htm

  2. ACC/AHA Task Force on Practice Guidelines (1996) Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the ACC/AHA Task Force Committee on perioperative evaluation for noncardiac surgery. Circulation 93: 1278–1317

    PubMed  Google Scholar 

  3. ACC/AHA Task Force on Practice Guidelines (2002) Guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary. A report of the ACC/AHA Task Force Committee on Practice Guidelines (Committee to update the 1996 guidelines on perioperative evaluation for noncardiac surgery. Circulation 105: 1257–1267

    PubMed  Google Scholar 

  4. Haas U, Motsch J (2003) Anästhesiekonzepte in der Gefäßchirurgie. Stellenwert von Regionalanästhesieverfahren. Anästhesist 52: 173–191

    Google Scholar 

  5. Goldmann L, Caldera DL, Nussbaum SR et al. (1977) Multifactor index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297: 845–850

    CAS  PubMed  Google Scholar 

  6. Sprung J, Abdelmalak B, Gottlieb A et al. (2000) Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anaesthesiology 93: 129–140

    Article  CAS  Google Scholar 

  7. Schunn CD, Hertzer NR, O’Hara PJ et al. (1998). Epidural versus general anesthesia: does anaesthetic management influence early infrainguinal graft thrombosis? Ann Vasc Surg 12: 65–69

    Article  CAS  PubMed  Google Scholar 

  8. Sbarigia E, daroVizza C, Antonini M et al. (1999) Locoregional versus general anaesthesia in carotid surgery: is there an impact on perioperative myocardial ischemia? Results of a prospective randomised trial. J Vasc Surg 30: 131–138

    CAS  PubMed  Google Scholar 

  9. Tangkanakul C, Counsell C, Warlow C (2000) Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst. Rev. 2000;CD000126

  10. Ragaller M, Albrecht DM (2000) Anästhesie in der Gefäßchirurgie (Teil II). Anaesthesiol Intensivmed Notfallmed Schmerzther 35: 571–591

    Article  CAS  Google Scholar 

  11. Richardson JD, Mainn KA (1989) Carotid endarterectomy in the elderly population: A statewide experience. J Vasc Surg 9: 65–67

    Article  CAS  PubMed  Google Scholar 

  12. Eastcott HH, Pickering GW, Rob CG (1954) Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet 6846: 994–996

    Article  Google Scholar 

  13. European Carotid Surgery Triallist Collaborative Group (1991) MRC European carotid surgery trial: Interim results for symptomatic patients with severe (70–99%) or mild (0–29%) carotid stenosis. Lancet 337: 1235–1243

    Article  PubMed  Google Scholar 

  14. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. NEJM 325: 445–453

    PubMed  Google Scholar 

  15. Naylor AR, Rothwell PM, Bell PRF (2003) Overview of the principal results and secondary analyses from the european and north american randomised trials of endarterectomy for symptomatic carotid stenosis. Eur J Vasc Endovasc Surg 26: 115–129

    Article  CAS  PubMed  Google Scholar 

  16. MCR Asymptomatic CAROTID Surgery Trial (ACST) Collaborative Group (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363: 1491–1502

    Article  CAS  PubMed  Google Scholar 

  17. Alamowitch S, Eliasziw M, Algra A, Meldrum H, Barnett HJ; North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group (2001) Risk, causes, and prevention of ischaemic stroke in elderly patients with symptomatic internal-carotid-artery stenosis. Lancet 357: 1154–1160

    Article  CAS  PubMed  Google Scholar 

  18. O’Hara PJ, Hertzer NR, Mascha EJ et al. (1998) Carotid endarterectomy in octogenarians: early results and late outcome J Vasc Surg 27 (5): 860–869

    Google Scholar 

  19. Coyle KA, Smith RB 3rd, Salam AA, Dodson TF, Chaikof EL, Lumsden AB (1994) Carotid endarterectomy in the octogenarian. Ann Vasc Surg 8 (5): 417–420

    CAS  PubMed  Google Scholar 

  20. Alozairi O, MacKenzie RK, Morgan R et al. (2003) Carotid endarterectomy in patients aged 75 and over: early results and late outcome. Eur J Vasc Endovasc Surg 26 (3): 245–249

    Article  CAS  PubMed  Google Scholar 

  21. Schneider JR, Droste JS, Schindler N, Golan JF (2000) Carotid endarterectomy in octogenarians: comparison with patient characteristics and outcomes in younger patients. J Vasc Surg 31 (5): 927–935

    Article  CAS  PubMed  Google Scholar 

  22. Fichtner-Feigl S, Larena-Avellaneda, Debus ES (2003) Überleben, Komplikationen und Risikofaktoren von rupturierten abdominellen Aortenaneurysmen. Gefäßchirurgie 8: 200–205

  23. Frame PS, Fryback DG, Patterson C (1993) Screening for abdominal aortic aneurysms in men ages 60 to 80 years. Ann Int Med 119: 411–416

    CAS  PubMed  Google Scholar 

  24. Multicentre Aneurysm Screening Study Group (2002) Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysm based on four year results from randomised controlled trial. B Med J 325: 1135–1142

    Google Scholar 

  25. Vorstand der deutschen Gesellschaft für Gefäßchirurgie (2003) Leitlinie zum Bauchaortenaneurysma. Gefäßchirurgie 8: 213–217

    Google Scholar 

  26. Lederle F, Wilson S, Johnson G et al. (2002) Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346: 1437–1444

    Article  PubMed  Google Scholar 

  27. The UK Small Aneurysm Trial Participants (1998) Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352: 1649–1655

    Article  PubMed  Google Scholar 

  28. The UK small Aneurysm Trial Participants (2002) Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 346: 1145–1451

    Article  PubMed  Google Scholar 

  29. Dimick JB, Cowan JA, Stanley JC et al. (2003) Surgeon speciality and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States. 38: 739–744

  30. Treiman RL, Levine KA, Cohen JL, Cossman DV, Foran RF, Levin PM (1982) Aneurysmectomy in the octogenarian. A study of morbidity and quality of survival. Am J Surg 144 (2): 194–197

    Article  CAS  PubMed  Google Scholar 

  31. Conway KP, Byrne J, Townsend M et al. (2001) Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era. J Vasc Surg 33: 752

    Article  CAS  PubMed  Google Scholar 

  32. Currie IC, Scott DJ, Robson AK, Horrocks M (1992) Quality of life of octogenarians after aneurysm surgery. Ann R Coll Surg Engl 74 (4): 269–273

    CAS  PubMed  Google Scholar 

  33. Harris LM, Faggioli GL, Fiedler R, Curl GR, Ricotta JJ (1991) Ruptured abdominal aneurysms: Factors affecting mortality rates. J Vasc Surg 14 (6): 812–818; discussion 819–820

    Article  CAS  PubMed  Google Scholar 

  34. Vemuri C, Wainess RM, Dimick JB, Cowan JA, Henke PK et al. (2004) Effect of increasing patient age on complication rates following intact abdominal aortic aneurysm repair in the unites states. J Surg Res 118: 26–31

    Article  PubMed  Google Scholar 

  35. Dimick JB, Stanley JC, Axelrod DA et al. (2002) Variation in death after abdominal aortic aneurysmectomy in the Unites States. Ann Surg 235: 579–585

    Article  PubMed  Google Scholar 

  36. Minor ME, Ellozy S, Carroccio A et al. (2004) Endovascular aortic aneurysm repair in the Octogerian. Is it worthwhile? Arch Surg 139: 308–314

    Article  PubMed  Google Scholar 

  37. Ritter R, Grabitz, Goderhardt E, Sandmann W (1997) Langzeitergebnisse nach Operation eines Bauchaortenaneurysma im Alter über 80 Jahre. Gefäßchirurgie 2: 5–10

  38. Mehta RH, Bossone E, Evangelista A et al. (2004) Acute type B dissection in elderly patients: clinical features, outcomes and simple risk stratification rule. Ann Thorac Surg 77 (5): 1622–1628

    Article  PubMed  Google Scholar 

  39. Hiatt WR (2001) Medical treatment of peripheral arterial disease and claudication. N Engl J Med 344: 1608

    CAS  Google Scholar 

  40. Diehm C, Schuster A, Allenberg JR et al. (2004) High prevalence of peripheral arterial disease an co-morbidity in 6880 primary care patients: cross sectional study. Atherosclerosis 172: 95–105

    Article  CAS  PubMed  Google Scholar 

  41. Fine-Edelstein JS, Wolf PA, O’Leary DH et al. (1994) Precursors of extracranial carotid atherosclerosis in the Framingham Study. Neurology 44 (6): 1046–1050

    CAS  PubMed  Google Scholar 

  42. TransAtlantic Inter-Society Consensus (TASC) Working Group (2000) Management of peripheral arterial disease (PAD). J Vasc Surg 31: 1–289

    PubMed  Google Scholar 

  43. Eskelinen E, Luther M, Eskelinen A, Lepantalo M (2003) Infrapopliteal bypasses reduces amputation incidence in elderly patients: a population-based study. Eur J Vasc Endovasc Surg 26: 65–68

    Article  CAS  PubMed  Google Scholar 

  44. Böckler D, Blaurock P, Mannsman U et al. (2004) Early surgical outcome after failed primary stenting for peripheral arterial occlusive disease (PAOD). J Endovasc Ther (in press)

  45. Tepohl G (2003) Jeder fünfte ältere Patient in der Praxis leidet an pAVK. Cardiovasc 3 (7): 16–20

    Google Scholar 

  46. Häring R (1997) Chirurgie im Alter. In: Häring R, Zilch H (Hrsg) Chirurgie, 4. völlig überarbeitete Aufl. de Gruyter, Berlin, S 214

  47. Siewert JR (2004) Der Chirurg—75 Jahre alt, aber nicht veraltet! Chirurg 75: 1–2

  48. Cicero MT (1924) Cato der Ältere. Über das Greisenalter. Verlag der Bremer Presse, München, S 16

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  1. Abteilung für Gefäßchirurgie, Vaskuläre und Endovaskuläre Chirurgie, Ruprecht-Karls-Universität Heidelberg

    D. Böckler, H. Schumacher & J.-R. Allenberg

  2. Abteilung für Gefäßchirurgie, Vaskuläre und Endovaskuläre Chirurgie, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg

    D. Böckler

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  1. D. Böckler
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  2. H. Schumacher
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Correspondence to D. Böckler.

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Böckler, D., Schumacher, H. & Allenberg, JR. Gefäßchirurgie im Alter. Chirurg 76, 113–125 (2005). https://doi.org/10.1007/s00104-004-0982-x

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