Periphere arterielle Verschlusskrankheit – Entwicklungen zur Morbidität und Letalität in Deutschland

Was ist neu?

Morbidität der peripheren arteriellen Verschlusskrankheit Die Mehrheit der Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) ist asymptomatisch. Bundesweite Analysen belegen einen überproportionalen Anstieg der pAVK, insbesondere des Anteils der Patienten mit einer schweren Form der pAVK, der sogenannten chronisch-kritischen Ischämie.

Trends hinsichtlich Risikofaktoren und Komorbiditäten, Amputation und Letalität Systematische Analysen zeigen, dass die Rate an Komorbiditäten und kardiovaskulären Risikofaktoren bei pAVK-Patienten stetig ansteigt, hier insbesondere Nieren- und Herzinsuffizienz. Verlaufsanalysen zeigen einen Rückgang der Major-Amputationsrate in den letzten Jahren, wenn auch auf Kosten eines Anstiegs der Minor-Amputationen. Die Gesamtzahl der ischämischen Amputationen bleibt jedoch weiterhin hoch (> 50 000/Jahr). Amputation und Letalität korrelieren mit dem klinischen Stadium (Schweregrad) der pAVK.

Ursachenforschung für die fehlende Prognoseverbesserung Die Prognose hinsichtlich Amputation und Letalität bei pAVK-Patienten ist im Vergleich zum historischen Kollektiv unverändert schlecht. Die spezifischen Ursachen dafür sind bisher nicht eindeutig geklärt, jedoch dürfte die mangelhafte Umsetzung der evidenzbasierten Therapieempfehlungen und Sekundärprävention eine wichtige Ursache und somit eine Zielgröße zukünftiger Therapiestrategie darstellen.

Abstract

The prevalence of peripheral artery disease (PAD) is increasing worldwide. Patients with PAD not only have a reduced quality of life, they are at high risk for cardiovascular events such as stroke, myocardial infarction and death. Recent nationwide studies in Germany demonstrate an increase of PAD burden, particularly of the advanced stages of PAD, i.e. of the subset with critical limb ischemia (CLI).

Despite the awareness campaigns and the advances in medical and technical management of the disease in the last decades, the total number of ischemic limb amputations in Germany remains high (> 50 000/year). The total number and the rate of minor amputation are increasing. However, the rate of major amputation is continuously decreasing (– 31% from 2005 to 2014). In contrast to the trend in major amputation, cardiovascular and overall mortality remains at high rates and almost unchanged compared to historical data. Limb amputation and mortality in patients with PAD strongly depends on disease severity: the risk of limb amputation at 4-years follow-up in patients at Rutherford categories 1 – 3, 4, 5 and 6 has been shown to be 4.6 %, 12.1 %, 35.3 % and 67.3 %, respectively, while the projected 4-years-mortality was 18.9 %, 37.7 %, 52.2 % and 63.5 %, respectively.

The causes for the lack of improvement of prognosis in PAD patients are unclear. However, the increase in comorbidity burden as well as the lack of adherence to evidence-based guidelines-recommended therapies, such as revascularization for CLI and secondary preventive measures, may play a pivotal role in the persistence of the poor prognosis of patients with PAD.

Schlüsselwörter

periphere arterielle Verschlusskrankheit - kritische Extremitätenischämie - Amputation - Morbidität - Letalität

Key words

peripheral arterial disease - critical limb ischemia - amputation - morbidity - mortality

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