nach oben

Surgery Today

Erschienen in:

26.11.2019 | Review Article

sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection

verfasst von: Nobuhisa Ohno, Kenji Minatoya

Erschienen in: Surgery Today | Ausgabe 11/2020

Einloggen, um Zugang zu erhalten

Abstract

A cannulation strategy in surgery for Stanford type A acute aortic dissection (AAAD) is integral for patient survival. Femoral cannulation has been the standard option for cannulation; however, there is increasing evidence that retrograde perfusion with femoral cannulation is associated with worse clinical outcomes, and new cannulation sites have been introduced in surgery for AAAD. Although axillary artery cannulation and central cannulation via the ascending aorta have become more popular than femoral access in recent years, adverse events have been reported and shifting cannulation sites during surgery are recommended by some surgeons. Therefore, it is beneficial for surgeons to broaden their knowledge about cannulation technology for AAAD. In this review, we discuss the various methods of cannulation for AAAD.

Inoue Y, Minatoya K, Oda T, Itonaga T, Seike Y, Tanaka H, et al. Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection. Eur J Cardiothorac Surg. 2016;50:567–73.PubMed

Lillehei CW, Cardozo RH. Use of median sternotomy with femoral artery cannulation in open cardiac surgery. Surg Gynecol Obstet. 1959;108:706–14.PubMed

Benedetto U, Raja SG, Amrani M, Pepper JR, Zeinah M, Tonelli E, et al. The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients. J Thorac Cardiovasc Surg. 2014;148:2936–43.PubMed

Svensson LG, Blackstone EH, Rajeswaran J, Sabik JF 3rd, Lytle BW, Gonzalez-Stawinski G, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–84; discussion 1274–84.

Parikh N, Trimarchi S, Gleason TG, Kamman AV, di Eusanio M, Myrmel T, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg. 2017;153:S74–S7979.PubMed

Peterson MD, Mazine A, El-Hamamsy I, Manlhiot C, Ouzounian M, MacArthur RG, et al. Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;150:824–31.PubMed

Abe T, Usui A. The cannulation strategy in surgery for acute type A dissection. Gen Thorac Cardiovasc Surg. 2017;65:1–9.PubMed

Rylski B, Urbanski PP, Siepe M, Beyersdorf F, Bachet J, Gleason TG, et al. Operative techniques in patients with type A dissection complicated by cerebral malperfusion. Eur J Cardiothorac Surg. 2014;46:156–66.PubMed

Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg. 2016;5:275–95.PubMedPubMedCentral

10.

DeBakey ME, Henly WS, Cooley DA, Crawford ES, Morris GC. Surgical treatment of dissecting aneurysm of the aorta analysis of seventy-two cases. Circulation. 1961;24:290.

11.

Fusco DS, Shaw RK, Tranquilli M, Kopf GS, Elefteriades JA. Femoral cannulation is safe for type A dissection repair. Ann Thorac Surg. 2004;78:1285–9.PubMed

12.

Thomas CS Jr, Alford WC Jr, Burrus GR, Frist RA, Stoney WS. The effectiveness of surgical treatment of acute aortic dissection. Ann Thorac Surg. 1978;26:42–9.PubMed

13.

Robicsek F, Guarino RL. Compression of the true lumen by retrograde perfusion during repair of aortic dissection. J Cardiovasc Surg (Torino). 1985;26:36–40.

14.

Parr GV, Manley NJ, Williams DR, Montesano RM. Obstruction of the true lumen during retrograde perfusion of type I aortic dissections: a simplified solution. Ann Thorac Surg. 1980;30:495–8.PubMed

15.

Pappas G, Starzl TE. Retrograde false channel perfusion: a complication of cardiopulmonary bypass during repair of dissecting aneurysms. Ann Thorac Surg. 1970;9:263–6.PubMedPubMedCentral

16.

Luciani N, Anselmi A, Glieca F, Lauria G, de Geest R, Possati G. Femoral cannulation with long arterial cannula in aortic dissection. Ann Thorac Surg. 2012;93:e45–e4747.PubMed

17.

Hou XT, Sun YQ, Zhang HJ, Zheng SH, Liu YY, Wang JG. Femoral artery cannulation in Stanford type A aortic dissection operations. Asian Cardiovasc Thorac Ann. 2006;14:35–7.PubMed

18.

David TE, Armstrong S, Ivanov J, Barnard S. Surgery for acute type A aortic dissection. Ann Thorac Surg. 1999;67:1999–2001.PubMed

19.

Immer FF, Aydin NB, Lütolf M, Krähenbühl ES, Stalder M, Englberger L, et al. Does aortic crossclamping during the cooling phase affect the early clinical outcome of acute type A aortic dissection? J Thorac Cardiovasc Surg. 2008;136:1536–40.PubMed

20.

Van Arsdell GS, David TE, Butany J. Autopsies in acute type A aortic dissection. Surgical implications. Circulation. 1998;98(19 Suppl):II299–302; discussion II302–4.

21.

Minatoya K, Ogino H, Matsuda H, Sasaki H. Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation. Interact Cardiovasc Thorac Surg. 2008;7:951–3.PubMed

22.

Tsiouris A, Elkinany S, Ziganshin BA, Elefteriades JA. Open Seldinger-guided femoral artery cannulation technique for thoracic aortic surgery. Ann Thorac Surg. 2016;101:2231–5.PubMed

23.

Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg. 1995;109:885–90; discussion 890–1.

24.

Carino D, Mori M, Pang PYK, Singh M, Elkinany S, Tranquilli M, et al. Direct axillary cannulation with open Seldinger-guided technique: is it safe? Eur J Cardiothorac Surg. 2018;53:1279–81.PubMed

25.

Pasic M, Schubel J, Bauer M, Yankah C, Kuppe H, Weng YG et al. Cannulation of the right axillary artery for surgery of acute type A aortic dissection. Eur J Cardiothorac Surg. 2003;24:231–35; discussion 235–6.

26.

Whitlark JD, Goldman SM, Sutter FP. Axillary artery cannulation in acute ascending aortic dissections. Ann Thorac Surg. 2000;69:1127–28; discussion 1129.

27.

Rylski B, Czerny M, Beyersdorf F, Kari FA, Siepe M, Adachi H, et al. Is right axillary artery cannulation safe in type A aortic dissection with involvement of the innominate artery? J Thorac Cardiovasc Surg. 2016;152:801–7.PubMed

28.

Imanaka K, Kawata M, Matsuoka T, Yamabi H. Uncertainty of axillary artery perfusion during surgery for acute aortic dissection. Ann Thorac Surg. 2014;97:1781–2.PubMed

29.

Imanaka K, Kyo S, Tanabe H, Ohuchi H, Asano H, Yokote Y. Fatal intraoperative dissection of the innominate artery due to perfusion through the right axillary artery. J Thorac Cardiovasc Surg. 2000;120:405–6.PubMed

30.

Hedayati N, Sherwood JT, Schomisch SJ, Carino JL, Markowitz AH. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli. J Thorac Cardiovasc Surg. 2004;128:386–90.PubMed

31.

Klotz S, Heuermann K, Hanke T, Petersen M, Sievers HH. Outcome with peripheral versus central cannulation in acute type A dissection dagger. Interact CardioVasc Thorac Surg. 2015;20:749–53.PubMed

32.

Sabashnikov A, Heinen S, Deppe A, Zeriouh M, Weymann A, Slottosch I, et al. Axillar or aortic cannulation for aortic repair in patients with stanford A dissection? Ann Thorac Surg. 2016;102:787–94.PubMed

33.

Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J. Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg. 2005;27:634–7.PubMed

34.

Battaloglu B, Erdil N, Nisanoglu V. Axillary artery perfusion in acute type A aortic dissection repair. J Card Surg. 2008;23:693–6.PubMed

35.

Watanabe K, Fukuda I, Osaka M, Imazuru T. Axillary artery and transapical aortic cannulation as an alternative to femoral artery cannulation. Eur J Cardiothorac Surg. 2003;23:842–3.PubMed

36.

Baek WK, Kim YS, Lee M, Yoon YH, Kim JT, Lim HK. Axillary artery cannulation in acute aortic dissection: a word of caution. Ann Thorac Surg. 2016;101:1573–4.PubMed

37.

Neri E, Massetti M, Capannini G, Carone E, Tucci E, Diciolla F, et al. Axillary artery cannulation in type a aortic dissection operations. J Thorac Cardiovasc Surg. 1999;118:324–9.PubMed

38.

Kano M, Chikugo F, Shimahara Y, Urata M, Hayamizu T. Left axillary artery perfusion in surgery of type A aortic dissection. Ann Thorac Cardiovasc Surg. 2008;14:22–4.PubMed

39.

Taşdemir O, Saritaş A, Küçüker S, Ozatik MA, Sener E. Aortic arch repair with right brachial artery perfusion. Ann Thorac Surg. 2002;73:1837–42.PubMed

40.

Numata S, Ogino H, Sasaki H, Hanafusa Y, Hirata M, Ando M, et al. Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion. Eur J Cardiothorac Surg. 2003;23:771–5; discussion 775.

41.

Ogino H, Sasaki H, Minatoya K, Matsuda H, Tanaka H, Watanuki H, et al. Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion. J Thorac Cardiovasc Surg. 2008;136:641–8; discussion 948–9.

42.

Lijoi A, Scarano F, Dottori V, Parodi E, Casali G, Bartolozzi F. Stanford type A aortic dissection. A new surgical approach. Tex Heart Inst J. 1998;25:65–7.

43.

Minatoya K, Karck M, Szpakowski E, Harringer W, Haverich A. Ascending aortic cannulation for Stanford type A acute aortic dissection: another option. J Thorac Cardiovasc Surg. 2003;125:952–3.PubMed

44.

Frederick JR, Yang E, Trubelja A, Desai ND, Szeto WY, Pochettino A, et al. Ascending aortic cannulation in acute type a dissection repair. Ann Thorac Surg. 2013;95:1808–11.PubMed

45.

Inoue Y, Ueda T, Taguchi S, Kashima I, Koizumi K, Takahashi R, et al. Ascending aorta cannulation in acute type A aortic dissection. Eur J Cardiothorac Surg. 2007;31:976–9; discussion 979–81.

46.

Reece TB, Tribble CG, Smith RL, Singh RR, Stiles BM, Peeler BB, et al. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg. 2007;133:428–34.PubMed

47.

Brinster DR, Parrish DW, Meyers KS, Reddy P, Kasirajan V. Central aortic cannulation for Stanford type A aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography. J Card Surg. 2014;29:729–32.PubMed

48.

Suzuki T, Asai T, Matsubayashi K, Kambara A, Kinoshita T, Hiramatsu N, et al. Safety and efficacy of central cannulation through ascending aorta for type A aortic dissection. Interact Cardiovasc Thorac Surg. 2010;11:34–7.PubMed

49.

Osumi M1, Wada H, Morita Y, Shimizu M, Sukehiro Y, Amako M, et al. Safety and efficacy of ascending aorta cannulation during repair of acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2014;62:296–300.

50.

Göbölös L, Philipp A, Foltan M, Wiebe K. Surgical management for Stanford type A aortic dissection: direct cannulation of real lumen at the level of the Botallo's ligament by Seldinger technique. Interact Cardiovasc Thorac Surg. 2008;7:1107–9.PubMed

51.

Ma H, Xiao Z, Shi J, Liu L, Qin C, Guo Y. Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection. J Cardiothorac Surg. 2018;13:106.PubMedPubMedCentral

52.

Taguchi S, Mori A, Suzuki R, Ishida O. Simplicity, skills, and pitfalls of ascending aortic cannulation for type A aortic dissection. J Cardiothorac Surg. 2013;8:161.PubMedPubMedCentral

53.

Jakob H, Tsagakis K, Szabo A, Wiese I, Thielmann M, Herold U. Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;134:244–5.PubMed

54.

Conzelmann LO, Weigang E, Kreitner KF, Vahl CF. True-lumen collapse of the ascending aorta in acute type A aortic dissection. Eur J Cardiothorac Surg. 2010;37:955.PubMed

55.

Yamamoto N, Nie M, Hari Y, Tanaka Y, Ohara K, Miyaji K. A selection of cases of direct cannulation in surgery for type A dissection. Asian Cardiovasc Thorac Ann. 2014;22:284–7.PubMed

56.

Kitamura T, Nie M, Horai T, Miyaji K. Direct True Lumen Cannulation ("Samurai" Cannulation) for Acute Stanford Type A Aortic Dissection. Ann Thorac Surg. 2017;104:e459–e461461.PubMed

57.

Kanamori T, Ichihara T, Sakaguchi H, Inoue T. A safe and rapid direct true lumen cannulation for acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2013;61:336–9.PubMed

58.

Trinkle JK, Bryant LR. Mechanical support of the circulation: a new approach. Arch Surg. 1970;101:740–3.PubMed

59.

Zwart HH, Kralios A, Kwan-Gett CS, Backman DK, Foote JL, Andrade JD, et al. First clinical application of transarterial closed-chest left ventricular (TaCLV) bypass. Trans Am Soc Artif Intern Organs. 1970;16:386–91.PubMed

60.

Mansfield PB. Transventricular aortic cannulation for cardiopulmonary bypass in newborn infants. J Pediatr Surg. 1972;7:398–403.PubMed

61.

Tanaka T, Kawamura T, Ohara K, Matsumoto M, Maeda H, Hiratsuka H. Transapical aortic perfusion with a double-barreled cannula. Ann Thorac Surg. 1978;25:209–14.PubMed

62.

Yamamoto S, Hosoda Y, Yamasaki M, Ishikawa N, Fuchimoto K, Fukuda T. Transapical aortic cannulation for acute aortic dissection to prevent malperfusion and cerebral complications. Tex Heart Inst J. 2001;28:42–3.PubMedPubMedCentral

63.

Flege JB Jr, Aberg T. Transventricular aortic cannulation for repair of aortic dissection. Ann Thorac Surg. 2001;72:955–6.PubMed

64.

Velissaris TJ, Tang AT, Ohri SK. Transventricular cannulation of the aorta: a useful technique in acute aortic dissection. Perfusion. 2001;16:155–7.PubMed

65.

Fukuda I, Aikawa S, Imazuru T, Osaka M. Transapical aortic cannulation for acute aortic dissection with diffuse atherosclerosis. J Thorac Cardiovasc Surg. 2002;123:369–70.PubMed

66.

Sosnowski AW, Jutley RS, Masala N, Alexiou C, Swanevelder J. How I do it: transapical cannulation for acute type-A aortic dissection. J Cardiothorac Surg. 2008;29(3):4.

67.

Wada S, Yamamoto S, Honda J, Hiramoto A, Wada H, Hosoda Y. Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations. J Thorac Cardiovasc Surg. 2006;132:369–72.PubMed

68.

Suenaga E, Sato M, Fumoto H, Kawasaki H, Koga S. Impact of transapical aortic cannulation for acute type A aortic dissection. Ann Thorac Cardiovasc Surg. 2015;21:382–7.PubMedPubMedCentral

69.

Djukanovic BP, Micovic S, Peric MS, Milojevic PS, Cirkovic MV, Boricic M, et al. The role of transapical cannulation in the operative management of acute aortic dissection. Perfusion. 2015;30:332–6.PubMed

70.

Terasaki T, Takano T, Fujii T, Seto T, Wada Y, Ohtsu Y, et al. Early and midterm results of transapical and right axillary artery cannulation for acute aortic dissection. J Cardiothorac Surg. 2015;10:2.PubMedPubMedCentral

71.

Matsushita A, Manabe S, Tabata M, Fukui T, Shimokawa T, Takanashi S. Efficacy and pitfalls of transapical cannulation for the repair of acute type A aortic dissection. Ann Thorac Surg. 2012;93:1905–9.PubMed

72.

Di Eusanio M, Quarti A, Pierri MD, Di Eusanio G. Cannulation of the brachiocephalic trunk during surgery of the thoracic aorta: a simplified technique for antegrade cerebral perfusion. Eur J Cardiothorac Surg. 2004;26:831–3.PubMed

73.

Di Eusanio M, Ciano M, Labriola G, Lionetti G, Di Eusanio G. Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients. Eur J Cardiothorac Surg. 2007;32:270–3.PubMed

74.

Chiu KM, Li SJ, Lin TY, Chan CY, Chu SH. Innominate artery cannulation for aortic surgery. Asian Cardiovasc Thorac Ann. 2007;15:348–50.PubMed

75.

Augoustides JG, Harris H, Pochettino A. Direct innominate artery cannulation in acute type a dissection and severe thoracic aortic atheroma. J Cardiothorac Vasc Anesth. 2007;2:727–9.

76.

Kaul P. How I do it–sole innominate cannulation for acute type A aortic dissection. J Cardiothorac Surg. 2012;7:125.PubMedPubMedCentral

77.

Kaul P. Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta–a case review. Perfusion. 2011;26:215–22.PubMed

78.

Preventza O, Bakaeen FG, Stephens EH, Trocciola SM, de la Cruz KI. Coselli JS Innominate artery cannulation: an alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery. J Thorac Cardiovasc Surg. 2013;145:S191–S196196.PubMed

79.

Rouchdy A, Abdelrahaman A. Cannulation of innominate artery as an alternative to axillary artery in repair for type A aortic dissection. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2018;26:83–8.

80.

Urbanski PP. Carotid artery cannulation in acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg. 2006;13:1398–9.

81.

Urbanski PP. Carotid artery cannulation in aortic surgery. Multimed Man Cardiothorac Surg. 2015; doi: 10.1093/mmcts/mmv026

82.

Urbanski PP, Lenos A, Lindemann Y, Weigang E, Zacher M, Diegeler A. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg. 2006;132:1398–403.PubMed

83.

Urbanski PP, Irimie V, Wagner M. Cannulation and perfusion strategy in acute aortic dissection involving both common carotid arteries. Interact Cardiovasc Thorac Surg. 2015;21:557–9.PubMed

84.

Talwar A, Wiadji E, Mathur MN. Experience with the axillary artery as an arterial cannulation site in patients with acute type A aortic dissection. Heart Lung Circ.s. 2018. https://doi.org/10.1016/j.hlc.2018.03.019(Epub ahead of print).CrossRef

85.

Orihashi K, Sueda T, Okada K, Imai K. Detection and monitoring of complications associated with femoral or axillary arterial cannulation for surgical repair of aortic dissection. J Cardiothorac Vasc Anesth. 2006;20:20–5.PubMed

86.

Rosinski BF, Idrees JJ, Roselli EE, Germano E, Pasadyn SR, Lowry AM, et al. Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach. J Thorac Cardiovasc Surg. 2018 doi: 10.1016/j.jtcvs.2018.11.137. [Epub ahead of print].

87.

Khaladj N, Shrestha M, Peterss S, Strueber M, Karck M, Pichlmaier M, et al. Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg. 2008;34:792–6; disussion 796.

Titel: sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection
verfasst von: Nobuhisa Ohno
Kenji Minatoya
Publikationsdatum: 26.11.2019
Verlag: Springer Singapore
Erschienen in: Surgery Today / Ausgabe 11/2020
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-019-01921-7

Neu im Fachgebiet Chirurgie

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

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

Springer Medizin

Abstract

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

Weitere Artikel der Ausgabe 11/2020

Recent advances in surgical strategies for alveolar echinococcosis of the liver

Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of the anastomosis after esophageal surgery

Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification

Effects of Daikenchuto on postoperative gastrointestinal motility in colorectal carcinoma patients with abdominal pain and distension: a prospective, randomized trial

Improvement in home-staging three-dimensional virtual surgical planning via webinar during the COVID-19 pandemic

Staged esophagectomy: surgical legacy or a bailout option?

Update Chirurgie