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S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK)

S1 guideline on intermittent pneumatic compression (IPC)

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Zusammenfassung

Unter Federführung der Deutschen Gesellschaft für Phlebologie e. V. (DGP) wurde im Januar 2018 in Kooperation mit weiteren Fachgesellschaften eine S1-Leitlinie zur intermittierenden pneumatischen Kompression (IPK) verabschiedet. Sie ersetzt die bisher existierende Leitlinie von 3/2005. Ziel der Leitlinie ist die Optimierung der Indikation und der therapeutischen Anwendung der IPK bei Gefäß- und Ödemerkrankungen. Es erfolgte eine ausgedehnte Literaturrecherche unter Berücksichtigung von Medline, existierenden Leitlinien sowie für das Thema relevanten, aber nicht gelisteten Arbeiten. Angesichts der vielfach methodisch schwachen Studienqualität mit oft kleinen Fallzahlen und heterogenen Behandlungsprotokollen lassen sich aus den vorhandenen Daten oft nur Empfehlungen unter Hinzuziehung der guten klinischen Praxis/Expertenkonsensus ableiten. Die apparative Anwendung pneumatischer Wechseldrücke dient der Thromboembolieprophylaxe, Entstauungstherapie bei Ödemerkrankungen und der positiven Beeinflussung der arteriellen und venösen Durchblutung mit Verbesserung der klinischen Symptome und schnellerer Ulkusheilung im ambulanten und stationären Bereich. Die eingesetzten Geräte und die Therapieschemata unterscheiden sich abhängig von ihrer Indikation und Ziellokalisation. Sie können ambulant und stationär sowie bei langfristiger Indikation auch als Heimgeräte eingesetzt werden. Eine Soll-Indikation besteht bei der Thromboseprophylaxe. Bei schwerer chronisch venöser Insuffizienz im Stadium C4b bis C6, beim Extremitätenlymphödem additiv und bei peripherer arterieller Verschlusskrankheit (pAVK) mit stabiler Claudicatio intermittens oder kritischer Ischämie sollte die IPK eingesetzt werden Bei posttraumatischen Ödemen, therapieresistenten venös bedingten Ödemen, beim Lipödem und bei Hemiplegie mit sensorischer Störung und Ödem kann die IPK zum Einsatz kommen. Absolute und relative Kontraindikationen zur IPK müssen berücksichtigt und Risiken beachtet und – soweit möglich – vermieden werden. Unerwünschte Ereignisse treten bei korrekter Anwendung der IPK extrem selten auf. Sie ist bei richtiger Indikationsstellung und Anwendung – auch additiv – eine effektive und sichere Therapiemethode insbesondere in der Behandlung der beschriebenen Gefäß- und Ödemerkrankungen sowie der Thromboseprophylaxe.

Abstract

Under the direction of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and in cooperation with other specialist associations, the S1 guideline on intermittent pneumatic compression (IPC) was adopted in January 2018. It replaces the previous guideline from March 2005. The aim of the guideline is to optimize the indication and therapeutic use of IPC in vascular diseases and edema. An extensive literature search of MEDLINE, existing guidelines, and work relevant to the topic was performed. In view of the often methodologically weak study quality with often small numbers of cases and heterogeneous treatment protocols, recommendations can often only be derived from the available data using good clinical practice/expert consensus. Intermittent pneumatic compression is used for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. The therapy regimens and devices used depend on the indication and target location. They can be used as outpatient and inpatient devices as well as at home for long-term indications. A target indication is thrombosis prophylaxis. IPC should be used in severe chronic venous insufficiency (stages C4b to C6), in extremity lymphedema as an add-on therapy and in peripheral arterial occlusive disease (PAOD) with stable intermittent claudication or critical ischemia. IPC can be used in post-traumatic edema, therapy-resistant venous edema, lipedema and hemiplegia with sensory deficits and edema. Absolute and relative contraindications to IPC must be taken into account and risks considered and avoided as far as possible. Adverse events are extremely rare if IPC is used correctly. If the indication and application are correct—also as an add-on therapy—it is a safe and effective treatment method, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.

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Authors and Affiliations

  1. Eschstr. 10, 21762, Otterndorf, Deutschland

    C. Schwahn-Schreiber

  2. Venenzentrum am Tegernsee, Tegernseerstr.3, 83703, Gmund am Tegernsee, Deutschland

    F. X. Breu

  3. Klinik und Poliklinik für Dermatologie, Sigmund Freud Str. 25, 53105, Bonn, Deutschland

    E. Rabe

  4. Klinik für Innere Medizin I – Kardiologie, Pulmologie, Angiologie, Städtisches Klinikum Brandenburg GmbH, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland

    I. Buschmann

  5. Ingeborg Bachmann-Weg 11, 9400, Wolfsberg, Österreich

    W. Döller

  6. Klinik für Gefäß- und Endovaskularchirurgie – Phlebologie – Lymphologie – Gefäß- und Lymphzentrum Nord-West, Klinikum Rheine/Mathias-Spital, Frankenburgstr. 31, 48341, Rheine, Deutschland

    G. R. Lulay

  7. die hautexperten, Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Deutschland

    A. Miller

  8. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    E. Valesky

  9. Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11–13, 44805, Bochum, Deutschland

    S. Reich-Schupke

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  1. C. Schwahn-Schreiber
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Correspondence to C. Schwahn-Schreiber.

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Interessenkonflikt

C. Schwahn-Schreiber, F.X. Breu, E. Rabe, I. Buschmann, W. Döller, G.R. Lulay, A. Miller, E. Valesky und S. Reich-Schupke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Langversion und Methodenreport der S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK) mit der Registernummer 037-007, die hier in leicht adaptierter Form abgedruckt wird, finden Sie unter http://www.awmf.org/leitlinien/detail/ll/037-007.html.

Beteiligte medizinisch-wissenschaftliche Fachgesellschaften

Deutsche Gesellschaft für Phlebologie e. V. (DGP), Gesellschaft Deutschsprachiger Lymphologen (GDL), Deutsche Gesellschaft für Lymphologie (DGL), Deutsche Dermatologische Gesellschaft (DDG), Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin e. V. (DGA), Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin – Gesellschaft für operative, endovaskuläre und präventive Gefäßmedizin e. V. (DGG)

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Schwahn-Schreiber, C., Breu, F.X., Rabe, E. et al. S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK). Hautarzt 69, 662–673 (2018). https://doi.org/10.1007/s00105-018-4219-1

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  • DOI: https://doi.org/10.1007/s00105-018-4219-1

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