Diabetes mellitus und periphere arterielle Verschlusskrankheit (PAVK)

Bundesweit steigt die Zahl stationär behandelter Patienten mit peripherer arterieller Verschlusskrankheit (PAVK). Dabei beträgt der Anteil der Diabetiker mit kritischer Extremitätenischämie mittlerweile fast 50 %. Demzufolge werden auch von den jährlich durchgeführten rund 16 000 hohen Amputationen infolge von Durchblutungsstörungen über 70 % bei Menschen mit Diabetes mellitus durchgeführt. Als nichtinvasive hämodynamische Funktionsuntersuchungen werden Knöchel- und Zehendruckmessungen, die Doppler-Pulskurvenanalyse, die Duplexsonografie und die transkutane Sauerstoffdruckmessung empfohlen und ermöglichen zusammen mit der bildgebenden Diagnostik die richtige Diagnose. Multimorbide diabetische Patienten mit kritischer Extremitätenischämie sollen, sofern möglich und bei geeigneter Expertise, zunächst endovaskulär revaskularisiert werden. Trotz einer etwas schlechteren Offenheitsrate ist die Beinerhaltungsrate dem Ergebnis nach einer Bypassanlage vergleichbar.

Throughout Germany the number of people being treated for peripheral arterial occlusive disease (PAOD) as inpatients in hospital is increasing. The proportion of these who are diabetics with severe limb ischaemia is now almost 50%. Of the 16,000 amputations performed annually as a result of circulatory disorders, therefore, over 70% are on people with diabetes mellitus. As non-invasive haemodynamic function examinations, ankle and toe pressure measurements, the Doppler pulse curve analysis, duplex sonography and transcutane oxygen pressure measurements are recommended and, together with imaging diagnostics, enable the correct diagnosis. Multi-morbid diabetic patients with severe limb ischaemia should, where possible and with appropriate expertise, initially undergo endovascular revascularisation. Despite a somewhat poorer patency rate, the rate of leg retention is comparable to the results following bypass procedure.

Key words

peripheral arterial occlusive disease (PAOD) - severe limb ischaemia - amputation - non-invasive haemodynamic function examinations - endovascular revascularisation - patency rate

• Literatur

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