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Erschienen in: Gefässchirurgie 8/2014

01.12.2014 | Leitthema

Stenosen von arteriovenösen Dialysefisteln

Typ-1-, Typ-2- und Typ-3-Stenosen

verfasst von: Prof. Dr. R. Kellersmann, R. Kickuth

Erschienen in: Gefässchirurgie | Ausgabe 8/2014

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Zusammenfassung

Hintergrund

Stenosen von arteriovenösen (AV-)Fisteln sind die häufigste Ursache für eine Dysfunktion oder den Verlust des Dialysezugangs. Das pathologische Korrelat der AV-Fistelstenose ist i. d. R. die neointimale Hyperplasie. Ihre Entstehung ist multifaktoriell. Hämodynamische Reize und mechanische Traumen induzieren einen komplexen Prozess von Inflammation, Regeneration und Degeneration, der letztlich zur Stenose führt.

Klassifikation

Basierend auf der Lokalisation der Einengung hat sich eine Einteilung in 4 Typen etabliert. Typ-1-Stenosen finden sich anastomosenah, Typ-2-Stenosen im Bereich der Punktionsareale. Typ-3-Stenosen sind an Einmündungen in das tiefe Venensystem lokalisiert und Typ-4-Stenosen in den zentralen Venenabschnitten.

Therapie

Für die Verhinderung der Entstehung von Shuntvenenstenosen sind in den letzten Jahren pharmakologische, zellbasierte und physikalische Strategien entwickelt worden. Die Therapieoptionen sind sowohl endovaskulär als auch chirurgisch. Die Wahl des Verfahrens erfordert eine individuelle Betrachtung verschiedenster lokaler, systemischer und prognostischer Faktoren und sollte möglichst in einem interdisziplinären Konzept erfolgen.
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Metadaten
Titel
Stenosen von arteriovenösen Dialysefisteln
Typ-1-, Typ-2- und Typ-3-Stenosen
verfasst von
Prof. Dr. R. Kellersmann
R. Kickuth
Publikationsdatum
01.12.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Gefässchirurgie / Ausgabe 8/2014
Print ISSN: 0948-7034
Elektronische ISSN: 1434-3932
DOI
https://doi.org/10.1007/s00772-014-1382-2

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CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis 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
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ 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
Berufsverband der Deutschen Chirurgie e.V.

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

CME: 2 Punkte

Dr. med. Mihailo Andric
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
Berufsverband der Deutschen Chirurgie e.V.