Zusammenfassung
Prospektiv randomisierte Studien und Register sind aufgrund ihres Evidenzniveaus Grundlage vieler medizinischer Entscheidungsprozesse. Was aber, wenn der individuelle Fall in den Studien nicht oder nur unzureichend abgebildet wird? Es wird der Fall einer kruralen Rekonstruktion bei Claudicatio einer 88-jährigen Patientin als Beispiel für die manchmal konträren Informationen aus hochwertigen Studien gezeigt. Gerade bei nicht eindeutiger Evidenz einer einzig richtigen Vorgehensweise ist die Rolle des Arztes und die unvoreingenommene Auswahl des Verfahrens von entscheidender Bedeutung.
Abstract
Prospective randomized trials (RCT) and registries have a high level of evidence. Thus, they play an important role in the process of diagnosis and treatment; however, many individual cases are not reflected or do not fulfil all the criteria. This article demonstrates individual decisions with the example of crural reconstruction in an 88-year-old woman who suffered from severe claudication. The RCTs and registries demonstrated the pros and cons of therapy; however, they did not properly reflect the individual case. The physician has to act individually according to fundamental principles of medical ethics.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Aboyans V, Ricco JB, Bartelink MEL et al (2018) 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39:763–816
Angiologie DGF (2015) S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit
Bodewes TCF, Darling JD, Deery SE et al (2018) Patient selection and perioperative outcomes of bypass and endovascular intervention as first revascularization strategy for infrainguinal arterial disease. J Vasc Surg 67:206–216
Diagnosis SECWGFTEGOT, Treatment of Peripheral Arterial D, Perez De Isla L et al (2018) Comments on the 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases. Rev Esp Cardiol (engl Ed) 71:74–78
Espinola-Klein C (2017) ESC guidelines 2017 on peripheral arterial diseases: summary of the most important recommendations and innovations. Herz 42:721–727
Gerhard-Herman MD, Gornik HL, Barrett C et al (2017) 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135:e726–e779
Hageman D, Pesser N, Gommans LNM et al (2018) Limited adherence to peripheral arterial disease guidelines and suboptimal ankle brachial index reliability in Dutch primary care. Eur J Vasc Endovasc Surg 55:867–873
Halliday A, Bax JJ (2018) The 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55:301–302
Harwood AE, Totty JP, Broadbent E et al (2017) Quality of life in patients with intermittent claudication. Gefasschirurgie 22:159–164
Jackson MR, Belott TP, Dickason T et al (2000) The consequences of a failed femoropopliteal bypass grafting: comparison of saphenous vein and PTFE grafts. J Vasc Surg 32:498–505
Kawarada O, Fujihara M, Higashimori A et al (2012) Predictors of adverse clinical outcomes after successful infrapopliteal intervention. Catheter Cardiovasc Interv 80:861–871
Koutakis P, Pipinos II, Myers SA et al (2010) Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication. J Vasc Surg 51:80–88
Lawall H, Huppert P, Espinola-Klein C et al (2016) Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit. Dtsch Arztebl Int 113:729–736
Mcdermott MM, Guralnik JM, Criqui MH et al (2014) Six-minute walk is a better outcome measure than treadmill walking tests in therapeutic trials of patients with peripheral artery disease. Circulation 130:61–68
Shirasu T, Hoshina K, Nishiyama A et al (2016) Favorable outcomes of very elderly patients with critical limb ischemia who undergo distal bypass surgery. J Vasc Surg 63:377–384
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
W. Lang gibt an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Rights and permissions
About this article
Cite this article
Lang, W. Die prospektiv randomisierten Studien und die Register helfen mir, aber nicht in vollem Umfang. Gefässchirurgie 23, 370–374 (2018). https://doi.org/10.1007/s00772-018-0416-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00772-018-0416-6