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Diabetisches Fußsyndrom (DFS) und periphere arterielle Verschlusskrankheit (PAVK): Überschneidungen und Unterschiede

Diabetic foot syndrome (DFS) and peripheral arterial occlusive disease (PAOD): overlaps and differences

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Zusammenfassung

Die isolierte periphere arterielle Verschlusskrankheit (PAVK) und das diabetische Fußsyndrom (DFS) unterscheiden sich pathophysiologisch stark. Die klinischen Symptome der PAVK ohne Diabetes mellitus (DM) korrelieren mit dem Schweregrad der arteriellen Verschlussprozesse. Beim DFS liegt eine behandlungswürdige PAVK zwar sehr häufig, nicht jedoch regelhaft vor. Die Ursache für die Fußläsionen beim DFS sind hauptsächlich Folge der diabetischen Polyneuropathie.

Diagnostik und Therapie beim DFS sind komplexer als bei der PAVK ohne DM. Für beide Krankheitsbilder ist eine sorgfältige gefäßmedizinische Untersuchung zur Planung der Therapie erforderlich. Die Revaskularisation ist sowohl bei der PAVK ohne DM als auch bei DFS mit relevanter PAVK wichtig, wobei sich die Methoden nicht unterscheiden. Beim DFS muss die Revaskularisation allerdings durch stadiengerechte Wundbehandlung, Druckentlastung und lebenslange Nachsorge und Tertiärprophylaxe ergänzt werden.

In dieser Arbeit werden Gemeinsamkeiten und wesentliche Unterschiede der beiden Krankheitsentitäten „PAVK ohne Neuropathie“ und DFS im Hinblick auf die Pathophysiologie, Diagnostik, Therapie und Nachsorge dargestellt.

Abstract

Isolated peripheral arterial occlusive disease (PAOD) and the diabetic foot syndrome (DFS) are pathophysiologically very different. The clinical symptoms of PAOD without diabetes mellitus (DM) correlate with the severity of the process of arterial occlusion. In DFS a PAOD in need of treatment is often but not always present. The cause of the foot lesions in DFS is predominantly sequela of the diabetic polyneuropathy.

The diagnostics and treatment in DFS are more complex than in PAOD without DM. A thorough vascular medical examination is necessary for planning the treatment of both disease patterns. Revascularization is important for PAOD without DM and also for DFS with a relevant PAOD, whereby the methods do not differ; however, in DFS the revascularization must be supplemented by a stage-oriented wound treatment, pressure relief, lifelong aftercare and tertiary prophylaxis.

This article presents the common features and the essential differences between the disease entities PAOD without neuropathy and DFS with respect to the pathophysiology, diagnostics, treatment and aftercare.

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Authors and Affiliations

  1. Gefäßzentrum Oberrhein, Abteilung für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer, Deutschland

    Gerhard Rümenapf

  2. Abteilung Diabetologie und Angiologie, Fachbereich Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland

    Stephan Morbach

  3. Oberrheinisches Gefäßzentrum Speyer, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Paul-Egell-Str. 33, 67346, Speyer, Deutschland

    Gerhard Rümenapf

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Correspondence to Gerhard Rümenapf.

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G. Rümenapf und S. Morbach geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rümenapf, G., Morbach, S. Diabetisches Fußsyndrom (DFS) und periphere arterielle Verschlusskrankheit (PAVK): Überschneidungen und Unterschiede. Gefässchirurgie 28, 199–207 (2023). https://doi.org/10.1007/s00772-023-00984-8

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