Zusammenfassung
Patienten mit akuter Extremitätenischämie (ALI) sollen notfallmäßig durch einen Klinker begutachtet werden, der genügend Erfahrung besitzt, um die Vitalität einer Gliedmaße zu bestimmen und die geeignete Therapie einzuleiten. Die Revaskularisationsstrategie kann von der Katheter-basierten Thrombolyse bis zur chirurgischen Thromboembolektomie reichen. Vorhandene Möglichkeiten und klinische Erfahrung sind Faktoren, die bei der Wahl der Revaskularisationsstrategie in Betracht gezogen werden sollten. Die Technik, die die schnellste Wiederherstellung des arteriellen Flusses bieten wird, mit dem geringsten Risiko für den Patienten, sollte gewählt werden.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
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 arteries. Endorsed 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
Baril DT, Patel VI, Judelson DR, Goodney PP, McPhee JT, Hevelone ND, Cronenwett JL, Schanzer A, Vascular Study Group of New England (2013) Outcomes of lower extremity bypass performed for acute limb ischemia. J Vasc Surg 58:949–956
Berridge DC, Kessel DO, Robertson I (2013) Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev (6):CD002784
Butt T, Gottsäter A, Apelqvist J, Engström G, Acosta S (2017) Outcome of intra-arterial thrombolysis in patients with diabetes and acute lower limb ischemia: a propensity score adjusted analysis. J Thromb Thrombolysis 44:475–480
Casillas-Berumen S, Sadri L, Farber A, Eslami MH, Kalish JA, Rybin D, Doros G, Siracuse JJ (2017) Morbidity and mortality after emergency lower extremity embolectomy. J Vasc Surg 65:754–759
Davis FM, Albright J, Gallagher KA, Gurm HS, Koenig GC, Schreiber T, Grossman PM, Henke PK (2018) Early outcomes following endovascular, open surgical, and hybrid revascularization for lower extremity acute limb ischemia. Ann Vasc Surg 51:106–112
Enezate TH, Omran J, Mahmud E, Patel M, Abu-Fadel MS, White CJ, Al-Dadah AS (2017) Endovascular versus surgical treatment for acute limb ischemia: a systematic review and meta-analysis of clinical trials. Cardiovasc Diagn Ther 7:264–271
Folkert IW, Foley PJ, Wang GJ, Jackson BM, Bavaria JE, Desai ND, Fairman RM, Damrauer SM (2018) Impact of acute postoperative limb ischemia after cardiac and thoracic aortic surgery. J Vasc Surg 67:1530–1536
Gandhi SS, Ewing JA, Cooper E, Chaves JM, Gray BH (2018) Comparison of low-dose catheter-directed thrombolysis with and without pharmacomechanical thrombectomy for acute lower extremity ischemia. Ann Vasc Surg 46:178–186
Genovese EA, Chaer RA, Taha AG, Marone LK, Avgerinos E, Makaroun MS, Baril DT (2016) Risk factors for long-term mortality and amputation after open and endovascular treatment of acute limb ischemia. Ann Vasc Surg 30:82–92
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. J Am Coll Cardiol 69:e71–e126
Grip O, Wanhainen A, Acosta S, Björck M (2017) Long-term outcome after thrombolysis for acute lower limb ischaemia. Eur J Vasc Endovasc Surg 53:853–861
Heller S, Lubanda JC, Varejka P, Chochola M, Prochazka P, Rucka D, Kuchynkova S, Horakova J, Linhart A (2017) Percutaneous mechanical thrombectomy using Rotarex® S device in acute limb ischemia in infrainguinal occlusions. Biomed Res Int 2017:2362769
Kempe K, Starr B, Stafford JM, Islam A, Mooney A, Lagergren E, Corriere MA, Edwards MS (2014) Results of surgical management of acute thromboembolic lower extremity ischemia. J Vasc Surg 60:702–707
Kronlage M, Printz I, Vogel B, Blessing E, Müller OJ, Katus HA, Erbel C (2017) A comparative study on endovascular treatment of (sub)acute critical limb ischemia: mechanical thrombectomy vs thrombolysis. Drug Des Devel Ther 11:1233–1241
Langenskiöld M, Smidfelt K, Karlsson A, Bohm C, Herlitz J, Nordanstig J (2017) Weak links in the early chain of care of acute lower limb ischaemia in terms of recognition and emergency management. Eur J Vasc Endovasc Surg 54:235–240
Lawall H, Huppert P, Rümenapf G, Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin (2015) S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. AWMF-Register Nr. 065/003
Lim S, Javorski MJ, Halandras PM, Kuo PC, Aulivola B, Crisostomo P (2018) Epidemiology, treatment, and outcomes of acute limb ischemia in the pediatric population. J Vasc Surg 68:182–188
Marqués de Marino P, Martínez López I, Revuelta Suero S, Hernández Mateo MM, Cernuda Artero I, Cabrero Fernández M, Serrano Hernando FJ (2016) Results of infrainguinal bypass in acute limb ischaemia. Eur J Vasc Endovasc Surg 51:824–830
Normahani P, Standfield NJ, Jaffer U (2017) Sources of delay in the acute limb ischemia patient pathway. Ann Vasc Surg 38:279–285
Patel NH, Krishnamurthy VN, Kim S, Saad WE, Ganguli S, Walker TG, Nikolic B, CIRSE and SIR Standards of Practice Committees (2013) Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia. J Vasc Interv Radiol 24:3–15
Piffaretti G, Angrisano A, Franchin M, Ferrario M, Rivolta N, Bacuzzi A, Castelli P, Tozzi M (2016) Risk factors analysis of thromboembolectomy for acute thromboembolic lower extremity ischemia in native arteries. J Cardiovasc Surg (Torino). [Epub ahead of print]
Schrijver AM, Vries JP de, Heuvel DA van den, Moll FL (2016) Long-term outcomes of catheter-directed thrombolysis for acute lower extremity occlusions of native arteries and prosthetic bypass grafts. Ann Vasc Surg 31:134–142
Taha AG, Byrne RM, Avgerinos ED, Marone LK, Makaroun MS, Chaer RA (2015) Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg 61:147–154
Urbak L, Motte L de la, Rørdam P, Siddiqi A, Sillesen H (2017) Catheter-directed thrombolysis in the treatment of acute ischemia in lower extremities is safe and effective, especially with concomitant endovascular treatment. Ann Vasc Dis 10:125–131
Wang JC, Kim AH, Kashyap VS (2016) Open surgical or endovascular revascularization for acute limb ischemia. J Vasc Surg 63:270–278
Wang SK, Murphy MP, Gutwein AR, Drucker NA, Dalsing MC, Motaganahalli RL, Lemmon GW, Akingba AG (2018a) Perioperative outcomes are adversely affected by poor pretransfer adherence to acute limb ischemia practice guidelines. Ann Vasc Surg 50:46–51
Wang SK, Lemmon GW, Drucker NA, Motaganahalli RL, Dalsing MC, Gutwein AR, Gray BW, Murphy MP (2018b) Results of nonoperative management of acute limb ischemia in infants. J Vasc Surg 67:1480–1483
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2019 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Debus, E.S., Grundmann, R.T. (2019). Akute Extremitätenischämie. In: Evidenzbasierte Gefäßchirurgie. Evidenzbasierte Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-57709-7_13
Download citation
DOI: https://doi.org/10.1007/978-3-662-57709-7_13
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-57708-0
Online ISBN: 978-3-662-57709-7
eBook Packages: Medicine (German Language)