Epidemiologie der peripheren arteriellen Verschlusskrankheit in Deutschland

Zusammenfassung

Die Prävalenz der peripheren arteriellen Verschlusskrankheit (pAVK) variiert mit der betrachteten Population und der angewandten Screening-Methode. Die Prävalenz der symptomatischen pAVK, die über einen Fragbogen erfasst wird, reicht von etwa 1% bei den 50-Jährigen bis zu 5% bei 80-Jährigen. Auf Grund der geringen Spezifität der Fragebögen hat diese Methode inzwischen keine Bedeutung mehr. In epidemiologischen Studien wird die Bestimmung des Knöchel/Arm-Indexes (ankle/brachial index, ABI) als Screening genutzt. Ein ABI <0,9 gilt als Nachweis einer pAVK. Basierend auf der ABI-Messung beträgt die Prävalenz der pAVK bei den 45- bis 49-jährigen Frauen bzw. Männern in Deutschland 2,3% bzw. 2,6%. Sie steigt bei den 70- bis 75-jährigen Frauen bereits auf 10,4% und bei den Männer dieser Altersgruppe auf 15,2% an. Da die ABIBestimmung mit einer Selektion von Menschen mit eher schlecht kompensierter pAVK einhergeht, liegt die wahre Prävalenz der pAVK vermutlich höher. Von den pAVK-Patienten haben die mit einer chronischen kritischen Ischämie (CKI) eine besonders schlechte Prognose hinsichtlich Extremitätenerhalt und Sterblichkeit. Exakte Prävalenzdaten zur CKI fehlen. Vermutlich sind von einer CKI mindestens 2% der pAVK-Patienten betroffen.

Summary

The prevalence of the peripheral arterial disease (PAD) varies with the analysed population and the screening method. The prevalence of the symptomatic PAD, derived from questionnaires, ranges from around 1% within the 50 years-old up to 5% within the 80 years-old. Due to the low specificity of such questionnaires this method has lost its relevance. In epidemiologic studies determination of the ankle/brachial index (ABI) is recommended for screening. ABI <0.9 indicates PAD. Based on the ABI the prevalence of the PAD in Germany in women aged 45-49 years is 2.3% and in men 2.6%. It increases to 10.4% and 15.2% in 70-75 years old women and men respectively. Real prevalence of PAD is assumed to be even higher, because ABI determination is biased to select people with more severe PAD and misses those with excellent collateral perfusion. Patients suffering from PAD with a chronic critical limb ischaemia (CLI) are characterised by the worst prognosis regarding limb salvage and mortality. Although the exact prevalence of CLI is unknown, it is assumed that CLI affects more than 2% of all PAD patients.

Schlüsselwörter

Periphere arterielle Verschlusskrankheit - chronisch kritische Ischämie - Mediasklerose - Knöchel/Arm-Index

Keywords

Peripheral arterial disease - chronic critical limb ischaemia - mediasclerosis - ankle/brachial index

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