Akute Ischämie bei Tumorpatienten: Pathogenese, Therapie und Prävention

Arterielle Thromboembolien machen ca. 10–30% aller tumorassoziierten thromboembolischen Komplikationen aus [1] und haben trotz Fortschritten in der medikamentösen und operativen Therapie der akuten peripheren Ischämie noch immer eine beträchtliche Mortalität bzw. Morbidität zur Folge [2]. Der vorliegende Beitrag schildert Pathophysiologie, Diagnostik und neueste Therapiemöglichkeiten der tumorassoziierten akuten Extremitätenischämie.

Abstract

Arterial thromboembolism accounts for approximately 10–30% of all tumour-associated thromboembolic complications and, despite advances in drug and surgical therapy of acute peripheral ischaemia, still results in considerable mortality and morbidity. This article describes the pathophysiology, diagnosis and latest therapeutic options for tumour-associated acute limb ischaemia.

Kernaussagen

• Patienten mit malignen Tumoren weisen zumeist bereits 6 Monate vor Diagnosestellung ein erhöhtes Risiko für thromboembolische Komplikationen auf.

• Sowohl die tumorspezifische Therapie als auch die Tumorerkrankung selbst können zu einer Veränderung der Gerinnungskaskade und zu Hyperkoagulabilität führen. Ergänzend liegen bei vielen Tumorpatienten auch klassische vaskuläre Risikofaktoren vor.

• Chemotherapeutika können einen akuten Vasospasmus, eine akute Thrombose und eine forcierte Atherosklerose hervorrufen.

• Im Zusammenhang mit einer Bestrahlung können Atherosklerose und Post-Radiatio-Dysfunktion als Folgen auftreten.

• Die Grundlage der Therapie bildet die Behandlung der kardiovaskulären Risikofaktoren.

• Im Rahmen der medikamentösen Behandlung wird bei thromboembolischen Ereignissen bei Patienten mit aktiver Malignität aktuell die Gabe von niedermolekularem Heparin favorisiert.

• Die neuesten Entwicklungen der vaskulären und endovaskulären Maßnahmen eröffnen auch für dieses Patientenkollektiv neue Möglichkeiten. Trotzdem bleibt die Mortalität nach peripheren Operationen bzw. Interventionen im Rahmen einer paraneoplastischen Thrombose extrem hoch.

Schlüsselwörter

Akute Extremitätenischämie - Tumorerkrankung - Pathogenese - Thrombektomie

Keywords

Acute limb ischemia - neoplastic disease - pathogenesis - thrombectomy

Publication History

Article published online:
01 March 2023

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