nach oben

Gefässchirurgie

Erschienen in:

30.06.2021 | Arteriosklerose | CME

Antithrombotische Therapie der peripheren arteriellen Verschlusskrankheit

verfasst von: Prof. Dr. E. S. Debus, C. Espinola-Klein, S. Honig, Ch.-A. Behrendt, R. Bauersachs

Erschienen in: Gefässchirurgie | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Mehr als 200 Mio. Menschen weltweit leiden an einer peripheren arteriellen Verschlusskrankheit (pAVK). Da die pAVK ein signifikanter Risikofaktor für das Auftreten von akuten vaskulären Ereignissen ist und demzufolge auch die Lebenserwartung der Betroffenen erheblich reduziert ist, gelten sie als Hochrisikopatienten. Die antithrombotische Therapie zählt zu den wichtigsten medikamentösen Eckpfeilern in der Prophylaxe dieser Ereignisse, aber der Effekt einer ASS(Acetylsalicylsäure)-basierten antithrombozytären Monotherapie ist begrenzt. Nun gibt es erstmals Hinweise, dass eine Kombination von ASS-basierter Monotherapie mit niedrig dosierter Antikoagulation (Rivaroxaban 2‑mal 2,5 mg) einen signifikanten zusätzlichen Nutzen für interventions- und nichtinterventionspflichtige Patienten mit symptomatischer pAVK erreichen kann. Diese neuen Erkenntnisse wurden aktuell in Leitlinien thematisiert und in neuen Empfehlungen zusammengefasst und haben erheblichen Einfluss auf die peri- und postinterventionelle antithrombotische Therapie von pAVK-Patienten.

Jones WS, Patel MR (2018) Antithrombotic therapy in peripheral artery disease: generating and translating evidence into practice. J Am Coll Cardiol 71(3):352–362PubMedCrossRef

Lawall H et al (2015) Update PAVK: epidemiology, comorbidity and prognosis of peripheral arterial obstructive disease. Dtsch Med Wochenschr 140(24):1798–1802PubMedCrossRef

Duvall WL, Vorchheimer DA (2004) Multi-bed vascular disease and atherothrombosis: scope of the problem. J Thromb Thrombolysis 17(1):51–61PubMedCrossRef

Hirsch AT et al (2006) ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American associations for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)—summary of recommendations. J Vasc Interv Radiol 17(9):1383–1397 (quiz 1398)PubMedCrossRef

Espinola-Klein C, Weisser G (2017) Vascular diagnostics in peripheral arteries. Internist (Berl) 58(8):787–795CrossRef

Criqui MH et al (1985) The prevalence of peripheral arterial disease in a defined population. Circulation 71(3):510–515PubMedCrossRef

Diehm C et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 172(1):95–105PubMedCrossRef

Song P, Rudan D, Zhu Y, Fowkes FJ, Rahimi K, Fowkes FGR, Rudan I (2019) Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health 7(8):e1020–e1030PubMedCrossRef

Disease GBD, Injury I, Prevalence C (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388(10053):1545–1602CrossRef

10.

Malyar N, Freisinger E, Reinecke H (2018) Peripheral arterial disease—trends in morbidity and mortality. Dtsch Med Wochenschr 143(11):766–770PubMedCrossRef

11.

Dohmen A et al (2015) S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit

12.

Darius H et al (2008) Comparison of two coronary risk equivalents: diabetes mellitus and peripheral arterial disease. Dtsch Med Wochenschr 133(45):2317–2322PubMedCrossRef

13.

Diehm C et al (2009) Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 120(21):2053–2061PubMedCrossRef

14.

Steg PG et al (2007) One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 297(11):1197–1206PubMedCrossRef

15.

Wolfe JHN (1986) Defining the outcome of critical ischaemia. A one year prospective study. Br J Surg 73:321–328

16.

Adam DJ et al (2005) Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 366(9501):1925–1934PubMedCrossRef

17.

Noronen K et al (2017) Analysis of the elective treatment process for critical limb ischaemia with tissue loss: diabetic patients require rapid revascularisation. Eur J Vasc Endovasc Surg 53(2):206–213PubMedCrossRef

18.

Kannel WB (1994) Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J Cardiovasc Risk 1(4):333–339PubMedCrossRef

19.

Wilterdink JL, Easton JD (1992) Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol 49(8):857–863PubMedCrossRef

20.

No authors listed (1994) National cholesterol education program. Second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). Circulation 89(3):1333–1445CrossRef

21.

Criqui MH et al (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326(6):381–386CrossRefPubMed

22.

Alahdab F et al (2015) A systematic review for the screening for peripheral arterial disease in asymptomatic patients. J Vasc Surg 61(3):42S–53SPubMedCrossRef

23.

AWMF (2010) Typ-2-Diabetes. Präventions-und Behandlungsstrategien für Fußkomplikationen

24.

Lindholt JS, Sogaard R (2017) Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial. Lancet 390(10109):2256–2265PubMedCrossRef

25.

European Association for Cardiovascular Prevention & Rehabilitation et al (2011) ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European society of cardiology (ESC) and the European atherosclerosis society (EAS). Eur Heart J 32(14):1769–1818CrossRef

26.

American Diabetes Association (2014) Standards of medical care in diabetes—2014. Diabetes Care 37(1):S14–80CrossRef

27.

Authors/Task Force Members et al (2013) ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European society of cardiology (ESC) and developed in collaboration with the European association for the study of diabetes (EASD). Eur Heart J 34(39):3035–3087CrossRef

28.

AWMF (2011) Neuropathie bei Diabetes im Erwachsenenalter

29.

Mancia G et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J 34(28):2159–2219PubMedCrossRef

30.

AWMF (2008) Nationale Versorgungsleitlinie Therapie des Typ 2 Diabetes

31.

Perk J et al (2012) European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 33(13):1635–1701PubMedCrossRef

32.

Willigendael EM et al (2004) Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg 40(6):1158–1165PubMedCrossRef

33.

Aboyans V, Thomas D, Lacroix P (2010) The cardiologist and smoking cessation. Curr Opin Cardiol 25(5):469–477PubMedCrossRef

34.

Jorenby DE et al (1999) A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 340(9):685–691PubMedCrossRef

35.

Steinberg MB et al (2009) Triple-combination pharmacotherapy for medically ill smokers: a randomized trial. Ann Intern Med 150(7):447–454PubMedCrossRef

36.

Hennrikus D et al (2010) Effectiveness of a smoking cessation program for peripheral artery disease patients: a randomized controlled trial. J Am Coll Cardiol 56(25):2105–2112PubMedCrossRef

37.

Daskalopoulou SS et al (2008) Association between ankle-brachial index and risk factor profile in patients newly diagnosed with intermittent claudication. Circ J 72(3):441–448PubMedCrossRef

38.

European Stroke Organisation et al (2011) ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the European society of cardiology (ESC). Eur Heart J 32(22):2851–2906CrossRef

39.

Stone NJ et al (2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol 63(25):2889–2934PubMedCrossRef

40.

Taylor F et al (2013) Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 1:CD4816

41.

Arao K et al (2017) Effects of pitavastatin on walking capacity and CD34(+)/133(+) cell number in patients with peripheral artery disease. Heart Vessels 32(10):1186–1194PubMedCrossRef

42.

Momsen AH et al (2009) Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg 38(4):463–474PubMedCrossRef

43.

Bonaca MP et al (2018) Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER trial (further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk). Circulation 137(4):338–350PubMedCrossRef

44.

Kroger K et al (2018) Peripheral arterial disease: when is a PCSK9 inhibitor useful? Dtsch Med Wochenschr 143(19):1391–1396PubMedCrossRef

45.

Adler AI et al (2002) UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes. Diabetes Care 25(5):894–899PubMedCrossRef

46.

Inzucchi SE et al (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American diabetes association (ADA) and the European association for the study of diabetes (EASD). Diabetes Care 35(6):1364–1379PubMedPubMedCentralCrossRef

47.

Lawall H (2017) Periphere arterielle Verschlusskrankheit und Diabetes mellitus. Empfehlungen zur Diagnostik und Therapie bei Diabetespatienten. Diabetologe. https://doi.org/10.1007/s11428-017-0283-xCrossRef

48.

Verma S et al (2018) Cardiovascular outcomes and safety of empagliflozin in patients with type 2 diabetes mellitus and peripheral artery disease: a subanalysis of EMPA-REG OUTCOME. Circulation 137(4):405–407PubMedCrossRef

49.

Zinman B et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373(22):2117–2128PubMedCrossRef

50.

Williams B et al (2018) 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension: the task force for the management of arterial hypertension of the European society of cardiology and the European society of hypertension. J Hypertens 36(10):1953–2041PubMedCrossRef

51.

Lane DA, Lip GY (2013) Treatment of hypertension in peripheral arterial disease. Cochrane Database Syst Rev 12:CD3075

52.

Espinola-Klein C et al (2011) Beta-Blockers in patients with intermittent claudication and arterial hypertension: results from the nebivolol or metoprolol in arterial occlusive disease trial. Hypertension 58(2):148–154PubMedCrossRef

53.

Bendermacher BL et al (2005) Medical management of peripheral arterial disease. J Thromb Haemost 3(8):1628–1637PubMedCrossRef

54.

Mehler PS et al (2003) Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes. Circulation 107(5):753–756PubMedCrossRef

55.

Group PS et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847CrossRef

56.

De Backer TL et al (2008) Naftidrofuryl for intermittent claudication. Cochrane Database Syst Rev 2:CD1368

57.

Boccalon H, Lehert P, Mosnier M (2001) Effect of naftidrofuryl on physiological walking distance in patients with intermittent claudication. Ann Cardiol Angeiol (Paris) 50(3):175–182CrossRef

58.

Bedenis R et al (2014) Cilostazol for intermittent claudication. Cochrane Database Syst Rev 10:CD3748

59.

Hiatt WR (2005) The US experience with cilostazol in treating intermittent claudication. Atheroscler Suppl 6(4):21–31PubMedCrossRef

60.

Aboyans V 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(9):763–816CrossRefPubMed

61.

Lawall H et al (2008) Stellenwert der Prostaglandine in der Behandlung der peripheren arteriellen Verschlusskrankheit (PAVK). Gefässchirurgie 13:164–170CrossRef

62.

Lawall H et al (2017) Efficacy and safety of alprostadil in patients with peripheral arterial occlusive disease fontaine stage IV: results of a placebo controlled randomised multicentre trial (ESPECIAL). Eur J Vasc Endovasc Surg 53(4):559–566PubMedCrossRef

63.

Zhang Y et al (2012) Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2 diabetes: a systematic review and meta-analysis. PLoS ONE 7(8):e42551PubMedPubMedCentralCrossRef

64.

Espinola-Klein C (2018) Anti-thrombotic treatment of patients with peripheral artery disease (PAD). Dtsch Med Wochenschr 143(15):1060–1064PubMedCrossRef

65.

Committee CS (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE steering committee. Lancet 348(9038):1329–1339CrossRef

66.

Creager MA (1998) Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events. Vasc Med 3(3):257–260PubMedCrossRef

67.

Morrow DA et al (2012) Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med 366(15):1404–1413PubMedCrossRef

68.

Bonaca MP et al (2013) Vorapaxar in patients with peripheral artery disease: results from TRA2{degrees}P-TIMI 50. Circulation 127(14):1522–9–1529e1–6CrossRef

69.

Bonaca MP et al (2016) Peripheral revascularization in patients with peripheral artery disease with vorapaxar: insights from the TRA 2 degrees P‑TIMI 50 trial. JACC Cardiovasc Interv 9(20):2157–2164PubMedCrossRef

70.

Tepe G et al (2012) Management of peripheral arterial interventions with mono or dual antiplatelet therapy—the MIRROR study: a randomised and double-blinded clinical trial. Eur Radiol 22(9):1998–2006PubMedCrossRef

71.

Strobl FF et al (2013) Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease. J Endovasc Ther 20(5):699–706PubMedCrossRef

72.

Fowkes FG et al (2010) Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA 303(9):841–848PubMedCrossRef

73.

Belch J et al (2008) The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 337:a1840PubMedPubMedCentralCrossRef

74.

Soejima H et al (2010) Aspirin for the primary prevention of cardiovascular events in patients with peripheral artery disease or diabetes mellitus. Analyses from the JPAD, POPADAD and AAA trials. Thromb Haemost 104(6):1085–1088PubMed

75.

Bonaca MP et al (2015) Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 372(19):1791–1800PubMedCrossRef

76.

Bonaca MP et al (2016) Ticagrelor for prevention of Ischemic events after myocardial infarction in patients with peripheral artery disease. J Am Coll Cardiol 67(23):2719–2728PubMedCrossRef

77.

Jones WS et al (2017) Ticagrelor compared with clopidogrel in patients with prior lower extremity revascularization for peripheral artery disease. Circulation 135(3):241–250PubMedCrossRef

78.

Bauersachs R, Zannad F (2018) Rivaroxaban: a new treatment paradigm in the setting of vascular protection? Thromb Haemost 118(S 01):S12–S22PubMedCrossRef

79.

Angiolillo DJ, Capodanno D, Goto S (2010) Platelet thrombin receptor antagonism and atherothrombosis. Eur Heart J 31(1):17–28PubMedCrossRef

80.

Moll F et al (2018) Edoxaban plus aspirin vs dual antiplatelet therapy in endovascular treatment of patients with peripheral artery disease: results of the ePAD trial. J Endovasc Ther 25(2):158–168PubMedCrossRef

81.

Eikelboom JW et al (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377(14):1319–1330PubMedCrossRef

82.

Anand SS et al (2018) Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 391(10117):219–229PubMedCrossRef

83.

Anand SS et al (2018) Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial. J Am Coll Cardiol 71(20):2306–2315PubMedCrossRef

84.

Bonaca MP et al (2016) Acute limb ischemia and outcomes with vorapaxar in patients with peripheral artery disease: results from the trial to assess the effects of vorapaxar in preventing heart attack and stroke in patients with atherosclerosis-thrombolysis in myocardial infarction 50 (TRA2 degrees P‑TIMI 50). Circulation 133(10):997–1005PubMedCrossRef

85.

Capell WH et al (2018) Rationale and design for the vascular outcomes study of ASA along with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease (VOYAGER PAD). Am Heart J 199:83–91PubMedCrossRef

86.

Bonaca MP et al (2020) Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med 382(21):1994–2004PubMedCrossRef

87.

Behrendt CA et al (2017) IDOMENEO – Ist die Versorgungsrealität in der Gefäßmedizin Leitlinien- und Versorgungsgerecht? Gefässchirurgie 22:41–47CrossRef

88.

Allie DE et al (2009) 24-carat gold, 14-carat gold, or platinum standards in the treatment of critical limb ischemia: bypass surgery or endovascular intervention? J Endovasc Ther 16(1):I134–46PubMed

89.

Cull DL et al (2010) Open versus endovascular intervention for critical limb ischemia: a population-based study. J Am Coll Surg 210(5):555–61–5561–3CrossRef

90.

Reinecke H et al (2015) Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J 36(15):932–938CrossRefPubMed

91.

Bradbury AW et al (2010) Bypass versus angioplasty in severe Ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 51(5):5S–17SPubMedCrossRef

92.

Dorros G et al (2001) Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation 104(17):2057–2062PubMedCrossRef

93.

Soder HK et al (2000) Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol 11(8):1021–1031PubMedCrossRef

94.

Brillu C et al (2001) Percutaneous transluminal angioplasty for management of critical ischemia in arteries below the knee. Ann Vasc Surg 15(2):175–181PubMedCrossRef

95.

Faglia E et al (2005) Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg 29(6):620–627PubMedCrossRef

96.

Berridge DC, Kessel D, Robertson I (2002) Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev 3:CD2784

97.

Schillinger M et al (2002) Balloon angioplasty and stent implantation induce a vascular inflammatory reaction. J Endovasc Ther 9(1):59–66PubMed

98.

Antithrombotic Trialists’ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324(7329):71–86CrossRef

99.

Sobel M, Verhaeghe R (2008) Antithrombotic therapy for peripheral artery occlusive disease: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6):815S–843SPubMedCrossRef

100.

Bhatt DL et al (2006) Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 354(16):1706–1717PubMedCrossRef

101.

No authors listed (2000) Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (the Dutch bypass oral anticoagulants or aspirin study): a randomised trial. Lancet 355(9201):346–351CrossRef

Titel: Antithrombotische Therapie der peripheren arteriellen Verschlusskrankheit
verfasst von: Prof. Dr. E. S. Debus
C. Espinola-Klein
S. Honig
Ch.-A. Behrendt
R. Bauersachs
Publikationsdatum: 30.06.2021
Verlag: Springer Medizin
Schlagwörter: Arteriosklerose
Periphere arterielle Verschlusskrankheit
Periphere arterielle Verschlusskrankheit
Acetylsalicylsäure
Rivaroxaban
Acetylsalicylsäure
Erschienen in: Gefässchirurgie / Ausgabe 5/2021
Print ISSN: 0948-7034
Elektronische ISSN: 1434-3932
DOI: https://doi.org/10.1007/s00772-021-00786-w

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich

weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2021

There is nothing so stable as change*

Evidenzbasierte Ernährung bei zerebrovaskulären und kardiovaskulären Erkrankungen

Was hat die Gefäßchirurgie für mich so faszinierend gemacht?

Offen und innovativ: Wie wird sich die offene Gefäßchirurgie weiterentwickeln?

Die Auswirkung von fokalen Therapiemaßnahmen auf die Behandlungsmöglichkeiten von komplexen Gefäßpathologien

Zur chirurgischen Behandlung der Varikophlebitis

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Hinter dieser Appendizitis steckte ein Erreger

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Ureterstriktur: Innovative OP-Technik bewährt sich

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“