Periphere arterielle Verschlusskrankheit bei Diabetikern – Eine Herausforderung in der Hausarztpraxis

Die periphere arterielle Verschlusskrankheit (PAVK) bei Diabetikern geht mit einer deutlich erhöhten Mortalität und Morbidität einher und wird insbesondere bei asymptomatischen Patienten unterdiagnostiziert und unterversorgt. Die Diagnostik einer PAVK bei Diabetikern stellt aufgrund der häufig bestehenden Symptomarmut und der eingeschränkten Verwertbarkeit der Bestimmung des Knöchel-Arm-Indexes eine besondere Herausforderung dar und erfordert eine differenzierte nichtinvasive hämodynamische Charakterisierung. Bei Patienten mit kritischer Durchblutungsstörung, insbesondere bei Diabetikern mit angiopathischem diabetischem Fußsyndrom, ist eine konsequente Diagnostik und Revaskularisation anzustreben, um die Prognose der Extremität zu verbessern, und darüber auch die Prognose quoad vitam. Dies erfordert eine enge Zusammenarbeit zwischen Hausärzten und Diabetologen einerseits, und Gefäßmedizinern andererseits.

Peripheral arterial disease (PAD) in diabetic patients is associated with markedly increased mortality and morbidity. This disorder is still underdiagnosed and undertreated. Diabetic patients with PAD often are asymptomatic until severe hemodynamic impairment leads to the development of ischemic lesions. The use of simple non-invasive diagnostic tools like measurement of ankle brachial blood pressure index is limited due to the high prevalence of mediasclerosis in diabetics leading to false high values. Hemodynamic characterization of diabetic patients with PAD therefore requires a differentiated approach using non-invasive and invasive testing. Patients with critical limb ischemia, especially patients with ischemic or neuroischemic diabetic foot ulcers should be revascularized whenever possible to improve limb and foot salvage rates. Preserving the extremity also prolongs the life span of diabetic patients. To achieve this goal close collaboration between general practioners, diabetologist and vascular specialists is mandatory.

Key words

Diabetes - peripheral arterial disease - diabetic foot syndrome - mediasclerosis - critical limb ischemia

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