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Perioperative Diagnose einer Thrombose

Diagnostic assessment of perioperative thromboembolism

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Summary

Venous thromboembolism (VTE) including deep vein thrombosis and pulmonary embolism is a frequent complication in postoperative setting. Despite advances in the diagnostic options conformation or exclusion of VTE remains a challenge. Preoperative assessment of thromboembolic risk factors may be helpful in estimating postoperative thromboembolic risk. Laboratory markers such as D-Dimer provide only limited information as they are modified by surgical intervention. Venous ultrasonography seems in postoperative setting a wide applicable diagnostic tool. However limited interpretation may be caused by bandage or oedema. Contrast venography und CT pulmonary angiography may be limited due to the nephrotoxic side effects of contrast agents especially in multimorbid patients. The development in magnetic resonance technology may overwhelm such problems. However magnetic implantates may also limit this modern diagnostic tool.

Zusammenfassung

Venöse Thromboembolien (VTE), wie die tiefe Beinvenenthrombose oder die Pulmonalembolie, sind eine häufige postoperative Komplikation. Trotz diagnostischer Fortschritte bleibt speziell im postoperativen Bereich der Nachweis oder Ausschluss einer VTE eine diagnostische Herausforderung. Die präoperative Erhebung von thrombembolischen Risikofaktoren ist ein wichtiger Faktor in der Abschätzung des postoperativen thrombembolischen Risikos. Laborparameter wie z. B. das D-Dimer sind nur bedingt aussagekräftig, da diese durch einen chirurgischen Eingriff massiv beeinflusst werden. Letztlich haben Ultraschalluntersuchungen – nicht zuletzt aufgrund der geringen Belastung für den Patienten – einen hohen diagnostischen Stellenwert. Verbände, perioperative Ödeme können jedoch die Interpretation der Ultraschallbefunde erschweren oder einschränken. Angiographische Methoden sind aufgrund der Nephrotoxizität der Kontrastmittel besonders bei multimorbiden Patienten nur bedingt anwendbar. Moderne Entwicklungen im Bereich der Magnetresonanz ermöglichen Untersuchungen mit nebenwirkungsarmen Kontrastmitteln, metallische Implantate limitieren jedoch den Einsatz der Magnetresonanz.

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  1. Abteilung für Anästhesie und Intensivmedizin, Medizinische Hochschule Hannover und Allgemeinmedizinische Praxis, Hohne, Germany

    Thomas Lang

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Lang, T. Perioperative Diagnose einer Thrombose. Wien Med Wochenschr 159, 492–500 (2009). https://doi.org/10.1007/s10354-009-0714-4

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