Skip to main content
Erschienen in: Indian Journal of Thoracic and Cardiovascular Surgery 3/2018

20.09.2018 | Review Article

The effect of storage solutions on endothelial function and saphenous vein graft patency

verfasst von: Ismail Bouhout, Walid Ben Ali, Louis Paul Perrault

Erschienen in: Indian Journal of Thoracic and Cardiovascular Surgery | Sonderheft 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Vein graft failure is a complex mechanism that can be triggered immediately after surgical harvesting. Storage solutions have a major role in preventing endothelial cell damage during harvesting. While normal saline is still widely used, buffered solutions seem to better preserve endothelial integrity and function. This review aims to summarize the current literature surrounding vein graft storage solutions.
Literatur
1.
Zurück zum Zitat Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a department of veterans affairs cooperative study. J Am Coll Cardiol. 2004;44:2149–56.CrossRefPubMed Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: Results from a department of veterans affairs cooperative study. J Am Coll Cardiol. 2004;44:2149–56.CrossRefPubMed
2.
Zurück zum Zitat McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg. 2016;102:132–8.CrossRefPubMed McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg. 2016;102:132–8.CrossRefPubMed
3.
Zurück zum Zitat de Vries MR, Simons KH, Jukema JW, Braun J, Quax PH. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol. 2016;13:451–70.CrossRefPubMed de Vries MR, Simons KH, Jukema JW, Braun J, Quax PH. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol. 2016;13:451–70.CrossRefPubMed
4.
Zurück zum Zitat Alexander JH, Hafley G, Harrington RA, et al. Efficacy and safety of edifoligide, an e2f transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: A randomized controlled trial. JAMA. 2005;294:2446–54.CrossRef Alexander JH, Hafley G, Harrington RA, et al. Efficacy and safety of edifoligide, an e2f transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: A randomized controlled trial. JAMA. 2005;294:2446–54.CrossRef
5.
Zurück zum Zitat Harskamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: Follow-up from the prevent iv randomized clinical trial. JAMA Surg. 2014;149:798–805.CrossRefPubMedPubMedCentral Harskamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: Follow-up from the prevent iv randomized clinical trial. JAMA Surg. 2014;149:798–805.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Williams JB, Harskamp RE, Bose S, et al. The preservation and handling of vein grafts in current surgical practice: Findings of a survey among cardiovascular surgeons of top-ranked us hospitals. JAMA Surg. 2015;150:681–3.CrossRefPubMed Williams JB, Harskamp RE, Bose S, et al. The preservation and handling of vein grafts in current surgical practice: Findings of a survey among cardiovascular surgeons of top-ranked us hospitals. JAMA Surg. 2015;150:681–3.CrossRefPubMed
7.
Zurück zum Zitat Schachner T. Pharmacologic inhibition of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2006;131:1065–72.CrossRefPubMed Schachner T. Pharmacologic inhibition of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2006;131:1065–72.CrossRefPubMed
8.
Zurück zum Zitat Schlitt A, Pruefer D, Buerke U, et al. Neutrophil adherence to activated saphenous vein and mammary endothelium after graft preparation. Ann Thorac Surg. 2006;81:1262–8.CrossRefPubMed Schlitt A, Pruefer D, Buerke U, et al. Neutrophil adherence to activated saphenous vein and mammary endothelium after graft preparation. Ann Thorac Surg. 2006;81:1262–8.CrossRefPubMed
9.
Zurück zum Zitat Weiss DR, Juchem G, Kemkes BM, Gansera B, Nees S. Extensive deendothelialization and thrombogenicity in routinely prepared vein grafts for coronary bypass operations: Facts and remedy. Int J Clin Exp Med. 2009;2:95–113.PubMedPubMedCentral Weiss DR, Juchem G, Kemkes BM, Gansera B, Nees S. Extensive deendothelialization and thrombogenicity in routinely prepared vein grafts for coronary bypass operations: Facts and remedy. Int J Clin Exp Med. 2009;2:95–113.PubMedPubMedCentral
10.
Zurück zum Zitat Shuhaiber JH, Evans AN, Massad MG, Geha AS. Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg. 2002;22:387–96.CrossRefPubMed Shuhaiber JH, Evans AN, Massad MG, Geha AS. Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery. Eur J Cardiothorac Surg. 2002;22:387–96.CrossRefPubMed
11.
Zurück zum Zitat Sur S, Sugimoto JT, Agrawal DK. Coronary artery bypass graft: Why is the saphenous vein prone to intimal hyperplasia? Can J Physiol Pharmacol. 2014;92:531–45.CrossRefPubMed Sur S, Sugimoto JT, Agrawal DK. Coronary artery bypass graft: Why is the saphenous vein prone to intimal hyperplasia? Can J Physiol Pharmacol. 2014;92:531–45.CrossRefPubMed
12.
Zurück zum Zitat Lamm P, Juchem G, Milz S, Reichart B. Continuous graft perfusion: Optimizing the quality of saphenous vein grafts. Heart Surg Forum. 2002;5:S355–61.PubMed Lamm P, Juchem G, Milz S, Reichart B. Continuous graft perfusion: Optimizing the quality of saphenous vein grafts. Heart Surg Forum. 2002;5:S355–61.PubMed
13.
Zurück zum Zitat Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361:235–44.CrossRefPubMed Lopes RD, Hafley GE, Allen KB, et al. Endoscopic versus open vein-graft harvesting in coronary-artery bypass surgery. N Engl J Med. 2009;361:235–44.CrossRefPubMed
14.
15.
Zurück zum Zitat Hinokiyama K, Valen G, Tokuno S, Vedin JB, Vaage J. Vein graft harvesting induces inflammation and impairs vessel reactivity. Ann Thorac Surg. 2006;82:1458–64.CrossRefPubMed Hinokiyama K, Valen G, Tokuno S, Vedin JB, Vaage J. Vein graft harvesting induces inflammation and impairs vessel reactivity. Ann Thorac Surg. 2006;82:1458–64.CrossRefPubMed
16.
Zurück zum Zitat Owens CD, Wake N, Conte MS, Gerhard-Herman M, Beckman JA. In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation. J Vasc Surg. 2009;50:1063–70.CrossRefPubMedPubMedCentral Owens CD, Wake N, Conte MS, Gerhard-Herman M, Beckman JA. In vivo human lower extremity saphenous vein bypass grafts manifest flow mediated vasodilation. J Vasc Surg. 2009;50:1063–70.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Loscalzo J. Vascular matrix and vein graft failure. Is the message in the medium? Circulation. 2000;101:221–3.CrossRefPubMed Loscalzo J. Vascular matrix and vein graft failure. Is the message in the medium? Circulation. 2000;101:221–3.CrossRefPubMed
18.
Zurück zum Zitat Taggart DP, Ben Gal Y, Lees B, et al. A randomized trial of external stenting for saphenous vein grafts in coronary artery bypass grafting. Ann Thorac Surg. 2015;99:2039–45.CrossRefPubMed Taggart DP, Ben Gal Y, Lees B, et al. A randomized trial of external stenting for saphenous vein grafts in coronary artery bypass grafting. Ann Thorac Surg. 2015;99:2039–45.CrossRefPubMed
19.
Zurück zum Zitat Kim KB, Hwang HY, Hahn S, Kim JS, Oh SJ. A randomized comparison of the saphenous vein versus right internal thoracic artery as a y-composite graft (save rita) trial: One-year angiographic results and mid-term clinical outcomes. J Thorac Cardiovasc Surg. 2014;148:901–7.CrossRefPubMed Kim KB, Hwang HY, Hahn S, Kim JS, Oh SJ. A randomized comparison of the saphenous vein versus right internal thoracic artery as a y-composite graft (save rita) trial: One-year angiographic results and mid-term clinical outcomes. J Thorac Cardiovasc Surg. 2014;148:901–7.CrossRefPubMed
20.
Zurück zum Zitat Catinella FP, Cunningham JN Jr, Srungaram RK, et al. The factors influencing early patency of coronary artery bypass vein grafts: Correlation of angiographic and ultrastructural findings. J Thorac Cardiovasc Surg. 1982;83:686–700.PubMed Catinella FP, Cunningham JN Jr, Srungaram RK, et al. The factors influencing early patency of coronary artery bypass vein grafts: Correlation of angiographic and ultrastructural findings. J Thorac Cardiovasc Surg. 1982;83:686–700.PubMed
21.
Zurück zum Zitat Sanchez AM, Wooldridge TA, Boerboom LE, Olinger GN, Almassi GH, Rusch NJ. Comparison of saphenous vein graft relaxation between plasma-lyte solution and normal saline solution. J Thorac Cardiovasc Surg. 1994;107:1445–53.PubMed Sanchez AM, Wooldridge TA, Boerboom LE, Olinger GN, Almassi GH, Rusch NJ. Comparison of saphenous vein graft relaxation between plasma-lyte solution and normal saline solution. J Thorac Cardiovasc Surg. 1994;107:1445–53.PubMed
22.
Zurück zum Zitat Hickethier T, Dammrich J, Silber RE, Finster S, Elert O. Ultrastructural investigations for reducing endothelial cell damage of vein grafts during CABG-operation and practical consequences. J Cardiovasc Surg (Torino). 1999;40:71–6. Hickethier T, Dammrich J, Silber RE, Finster S, Elert O. Ultrastructural investigations for reducing endothelial cell damage of vein grafts during CABG-operation and practical consequences. J Cardiovasc Surg (Torino). 1999;40:71–6.
23.
Zurück zum Zitat Kown MH, Yamaguchi A, Jahncke CL, et al. L-arginine polymers inhibit the development of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2001;121:971–80.CrossRefPubMed Kown MH, Yamaguchi A, Jahncke CL, et al. L-arginine polymers inhibit the development of vein graft neointimal hyperplasia. J Thorac Cardiovasc Surg. 2001;121:971–80.CrossRefPubMed
24.
Zurück zum Zitat Biswas KS, Thatte HS, Najjar SF, et al. Multi-photon microscopy in the evaluation of human saphenous vein. J Surg Res. 2001;95:37–43.CrossRefPubMed Biswas KS, Thatte HS, Najjar SF, et al. Multi-photon microscopy in the evaluation of human saphenous vein. J Surg Res. 2001;95:37–43.CrossRefPubMed
25.
Zurück zum Zitat Wilbring M, Tugtekin SM, Zatschler B, et al. Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts. Eur J Cardiothorac Surg. 2011;40:811–5.PubMed Wilbring M, Tugtekin SM, Zatschler B, et al. Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts. Eur J Cardiothorac Surg. 2011;40:811–5.PubMed
26.
Zurück zum Zitat Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg. 1990;100:612–20.PubMed Lawrie GM, Weilbacher DE, Henry PD. Endothelium-dependent relaxation in human saphenous vein grafts. Effects of preparation and clinicopathologic correlations. J Thorac Cardiovasc Surg. 1990;100:612–20.PubMed
27.
Zurück zum Zitat Bush HL Jr, Jakubowski JA, Curl GR, Deykin D, Nabseth DC. The natural history of endothelial structure and function in arterialized vein grafts. J Vasc Surg. 1986;3:204–15.CrossRefPubMed Bush HL Jr, Jakubowski JA, Curl GR, Deykin D, Nabseth DC. The natural history of endothelial structure and function in arterialized vein grafts. J Vasc Surg. 1986;3:204–15.CrossRefPubMed
28.
Zurück zum Zitat Chester AH, O'Neil GS, Tadjakarimi S, Borland JA, Yacoub MH. Effect of peri-operative storage solution on the vascular reactivity of the human saphenous vein. Eur J Cardiothorac Surg. 1993;7:399–404.CrossRefPubMed Chester AH, O'Neil GS, Tadjakarimi S, Borland JA, Yacoub MH. Effect of peri-operative storage solution on the vascular reactivity of the human saphenous vein. Eur J Cardiothorac Surg. 1993;7:399–404.CrossRefPubMed
29.
Zurück zum Zitat Cavallari N, Abebe W, Mingoli A, et al. Functional and morphological evaluation of canine veins following preservation in different storage media. J Surg Res. 1997;68:106–15.CrossRefPubMed Cavallari N, Abebe W, Mingoli A, et al. Functional and morphological evaluation of canine veins following preservation in different storage media. J Surg Res. 1997;68:106–15.CrossRefPubMed
30.
Zurück zum Zitat Wilbring M, Ebner A, Schoenemann K, et al. Heparinized blood better preserves cellular energy charge and vascular functions of intraoperatively stored saphenous vein grafts in comparison to isotonic sodium-chloride-solution. Clin Hemorheol Microcirc. 2013;55:445–55.PubMed Wilbring M, Ebner A, Schoenemann K, et al. Heparinized blood better preserves cellular energy charge and vascular functions of intraoperatively stored saphenous vein grafts in comparison to isotonic sodium-chloride-solution. Clin Hemorheol Microcirc. 2013;55:445–55.PubMed
31.
Zurück zum Zitat Gundry SR, Jones M, Ishihara T, Ferrans VJ. Optimal preparation techniques for human saphenous vein grafts. Surgery. 1980;88:785–94.PubMed Gundry SR, Jones M, Ishihara T, Ferrans VJ. Optimal preparation techniques for human saphenous vein grafts. Surgery. 1980;88:785–94.PubMed
32.
Zurück zum Zitat Santoli E, Di Mattia D, Boldorini R, Mingoli A, Tosoni A, Santoli C. University of wisconsin solution and human saphenous vein graft preservation: Preliminary anatomic report. Eur J Cardiothorac Surg. 1993;7:548–52.CrossRefPubMed Santoli E, Di Mattia D, Boldorini R, Mingoli A, Tosoni A, Santoli C. University of wisconsin solution and human saphenous vein graft preservation: Preliminary anatomic report. Eur J Cardiothorac Surg. 1993;7:548–52.CrossRefPubMed
33.
Zurück zum Zitat Dumanski A, Sopel M, Pelczar M, Szlapka M, Kustrzycki W, Zabel M. Influence of pressure on the endothelium of the saphenous vein coronary artery bypass graft. In Vivo. 2007;21:785–9.PubMed Dumanski A, Sopel M, Pelczar M, Szlapka M, Kustrzycki W, Zabel M. Influence of pressure on the endothelium of the saphenous vein coronary artery bypass graft. In Vivo. 2007;21:785–9.PubMed
34.
Zurück zum Zitat Tsakok M, Montgomery-Taylor S, Tsakok T. Storage of saphenous vein grafts prior to coronary artery bypass grafting: Is autologous whole blood more effective than saline in preserving graft function? Interact Cardiovasc Thorac Surg. 2012;15:720–5.CrossRefPubMedPubMedCentral Tsakok M, Montgomery-Taylor S, Tsakok T. Storage of saphenous vein grafts prior to coronary artery bypass grafting: Is autologous whole blood more effective than saline in preserving graft function? Interact Cardiovasc Thorac Surg. 2012;15:720–5.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Wise ES, Hocking KM, Cheung-Flynn J, Brophy CM. Balanced, ph-buffered preservation solutions improved physiologic response in human saphenous vein graft. Arterioscler Thromb Vasc Biol. 2014;34:A322. Wise ES, Hocking KM, Cheung-Flynn J, Brophy CM. Balanced, ph-buffered preservation solutions improved physiologic response in human saphenous vein graft. Arterioscler Thromb Vasc Biol. 2014;34:A322.
36.
Zurück zum Zitat Bas M, Luther B, Knopf A, Suvorava T, Kojda G. Preservation of endothelial and smooth muscle function of human saphenous vein transplants. Exp Clin Transplant. 2016;14:86–92.PubMed Bas M, Luther B, Knopf A, Suvorava T, Kojda G. Preservation of endothelial and smooth muscle function of human saphenous vein transplants. Exp Clin Transplant. 2016;14:86–92.PubMed
37.
Zurück zum Zitat Schaeffer U, Strohschneider T, Pilch H, et al. Influence of several solutions used in bypass surgery on the perrmeability of the endothelium of carotid arteries in new zealand rabbits. Thorac Cardiovasc Surg. 1999;47:240–3.CrossRefPubMed Schaeffer U, Strohschneider T, Pilch H, et al. Influence of several solutions used in bypass surgery on the perrmeability of the endothelium of carotid arteries in new zealand rabbits. Thorac Cardiovasc Surg. 1999;47:240–3.CrossRefPubMed
38.
Zurück zum Zitat Garbe S, Zatschler B, Muller B, et al. Preservation of human artery function following prolonged cold storage with a new solution. J Vasc Surg. 2011;53:1063–70.CrossRefPubMed Garbe S, Zatschler B, Muller B, et al. Preservation of human artery function following prolonged cold storage with a new solution. J Vasc Surg. 2011;53:1063–70.CrossRefPubMed
39.
Zurück zum Zitat Veres G, Hegedus P, Barnucz E, et al. Tiprotec preserves endothelial function in a rat model. J Surg Res. 2016;200:346–55.CrossRefPubMed Veres G, Hegedus P, Barnucz E, et al. Tiprotec preserves endothelial function in a rat model. J Surg Res. 2016;200:346–55.CrossRefPubMed
40.
Zurück zum Zitat Wilbring M, Tugtekin SM, Zatschler B, et al. Preservation of endothelial vascular function of saphenous vein grafts after long-time storage with a recently developed potassium-chloride and n-acetylhistidine enriched storage solution. Thorac Cardiovasc Surg. 2013;61:656–62.PubMed Wilbring M, Tugtekin SM, Zatschler B, et al. Preservation of endothelial vascular function of saphenous vein grafts after long-time storage with a recently developed potassium-chloride and n-acetylhistidine enriched storage solution. Thorac Cardiovasc Surg. 2013;61:656–62.PubMed
41.
Zurück zum Zitat He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993;55:1210–7.CrossRefPubMed He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993;55:1210–7.CrossRefPubMed
42.
Zurück zum Zitat Wise ES, Hocking KM, Luo W, et al. Traditional graft preparation decreases physiologic responses, diminishes viscoelasticity, and reduces cellular viability of the conduit: A porcine saphenous vein model. Vasc Med. 2016;21:413–21.CrossRefPubMedPubMedCentral Wise ES, Hocking KM, Luo W, et al. Traditional graft preparation decreases physiologic responses, diminishes viscoelasticity, and reduces cellular viability of the conduit: A porcine saphenous vein model. Vasc Med. 2016;21:413–21.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Thatte HS, Biswas KS, Najjar SF, et al. Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA. Ann Thorac Surg. 2003;75:1145–52.CrossRefPubMed Thatte HS, Biswas KS, Najjar SF, et al. Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA. Ann Thorac Surg. 2003;75:1145–52.CrossRefPubMed
44.
Zurück zum Zitat Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001;72:S2245–52.CrossRefPubMed Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001;72:S2245–52.CrossRefPubMed
45.
Zurück zum Zitat Bhardwaj S, Roy H, Yla-Herttuala S. Gene therapy to prevent occlusion of venous bypass grafts. Expert Rev Cardiovasc Ther. 2008;6:641–52.CrossRefPubMed Bhardwaj S, Roy H, Yla-Herttuala S. Gene therapy to prevent occlusion of venous bypass grafts. Expert Rev Cardiovasc Ther. 2008;6:641–52.CrossRefPubMed
46.
Zurück zum Zitat Chandiwal A, Balasubramanian V, Baldwin ZK, Conte MS, Schwartz LB. Gene therapy for the extension of vein graft patency: A review. Vasc Endovascular Surg. 2005;39:1–14.CrossRefPubMed Chandiwal A, Balasubramanian V, Baldwin ZK, Conte MS, Schwartz LB. Gene therapy for the extension of vein graft patency: A review. Vasc Endovascular Surg. 2005;39:1–14.CrossRefPubMed
47.
Zurück zum Zitat Alexander JH, Ferguson TB Jr, Joseph DM, et al. The project of ex-vivo vein graft engineering via transfection iv (prevent iv) trial: Study rationale, design, and baseline patient characteristics. Am Heart J. 2005;150:643–9.CrossRefPubMed Alexander JH, Ferguson TB Jr, Joseph DM, et al. The project of ex-vivo vein graft engineering via transfection iv (prevent iv) trial: Study rationale, design, and baseline patient characteristics. Am Heart J. 2005;150:643–9.CrossRefPubMed
48.
Zurück zum Zitat Stahli BE, Gebhard C, Duchatelle V, et al. Effects of the P-selectin antagonist inclacumab on myocardial damage after percutaneous coronary intervention according to timing of infusion: Insights from the SELECT-ACS trial. J Am Heart Assoc. 2016;5.pii:e004255. Stahli BE, Gebhard C, Duchatelle V, et al. Effects of the P-selectin antagonist inclacumab on myocardial damage after percutaneous coronary intervention according to timing of infusion: Insights from the SELECT-ACS trial. J Am Heart Assoc. 2016;5.pii:e004255.
49.
Zurück zum Zitat Nakao A, Huang CS, Stolz DB, et al. Ex vivo carbon monoxide delivery inhibits intimal hyperplasia in arterialized vein grafts. Cardiovasc Res. 2011;89:457–63.CrossRefPubMed Nakao A, Huang CS, Stolz DB, et al. Ex vivo carbon monoxide delivery inhibits intimal hyperplasia in arterialized vein grafts. Cardiovasc Res. 2011;89:457–63.CrossRefPubMed
Metadaten
Titel
The effect of storage solutions on endothelial function and saphenous vein graft patency
verfasst von
Ismail Bouhout
Walid Ben Ali
Louis Paul Perrault
Publikationsdatum
20.09.2018
Verlag
Springer Singapore
Erschienen in
Indian Journal of Thoracic and Cardiovascular Surgery / Ausgabe Sonderheft 3/2018
Print ISSN: 0970-9134
Elektronische ISSN: 0973-7723
DOI
https://doi.org/10.1007/s12055-018-0720-5

Weitere Artikel der Sonderheft 3/2018

Indian Journal of Thoracic and Cardiovascular Surgery 3/2018 Zur Ausgabe

Update Chirurgie

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

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
Berufsverband der Deutschen Chirurgie e.V.

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
Berufsverband der Deutschen Chirurgie e.V.

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
Berufsverband der Deutschen Chirurgie e.V.