Download PDF
Dtsch Med Wochenschr 2020; 145(22): 1606-1613
DOI: 10.1055/a-1047-7742
Dossier

Makroangiopathie bei Diabetes mellitus

Macroangiopathy in diabetes mellitus
Holger Lawall
,
Philipp Geisbüsch
,
Ralf Lobmann
› Further Information
Also available at
    Permissions and Reprints

Die pAVK ist weit verbreitet, aber unterdiagnostiziert bei Patienten mit Diabetes und selbst bei Patienten mit diabetischen Fußulzerationen. Der Artikel möchte das Bewusstsein für die klinische Manifestation, einschließlich Claudicatio intermittens und kritischer Ischämie der Gliedmaßen, schärfen und stellt die aktuellen Standards im Rahmen des evidenzbasierten interdisziplinären Managements dar.

Abstract

Peripheral artery occlusive disease is a prevalent but underdiagnosed manifestation in patients with diabetes and also in patients with diabetic foot ulceration. There is insufficient awareness of its clinical manifestations, including intermittent claudication and critical limb ischemia and of its risk of adverse limb outcomes. This review aims to highlight essential elements of the prevalence of peripheral artery disease in patients with diabetes and the the pathway of clinical diagnosis. We report the actual standards and evidence based, interdisciplinary management including conservative, interventional and surgical treatment options and also the needs of follow-up care.

Schlüsselwörter

Makroangiopathie - Arteriosklerose - Diabetes mellitus

Key words

macroangiopathy - peripheral occlusive disease - diabetes


Publication History

Article published online:
03 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Diehm C, Darius H, Burghaus I. et al. Anklebrachial index vs metabolic syndrome for risk prediction. Lancet 2008; 372: 1221
    CrossrefPubMedGoogle Scholar
  • 2 Lawall H, Lüdemann C. Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit bei Diabetespatienten. Diabetologie 2015; 11: 12-21
    CrossrefPubMedGoogle Scholar
  • 3 S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. Stand 30. September 2015; AWMF-Register Nr. 065/003 Entwicklungsstufe S3. Im Internet (Stand: 29.09.2020): https://www.awmf.org/leitlinien/detail/ll/065–003.html
    PubMedGoogle Scholar
  • 4 Balletshofer B, Ito W, Lawall H. et al. Positionspapier zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK) bei Menschen mit Diabetes mellitus. Diabetologie und Stoffwechsel 2019; 14 (Suppl. 02) S258-S266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Freisinger E, Malyar NM, Reinecke H. et al. Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardiovasc Diabetol 2017; 16 (01) 41
    CrossrefPubMedGoogle Scholar
  • 6 Morbach S, Lobmann R, Eckhard M. et al. Praxisleitlinie Diabetisches Fußsyndrom. Diabetol Stoffwechsel 2019; 14 (Suppl. 02) 267-277
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hinchcliff RJ, Forsythe RO, Apelquist J. et al Guidelines on prognosis and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; DOI: doi.org/10.1002/dmrr.3276. ; Stand: 29.09.2020
    CrossrefPubMedGoogle Scholar
  • 8 Lawall H. Diabetisches Fußsyndrom – der vergessene Gefäßpatient. Diabetologe 2020; 16: 339-348
    CrossrefPubMedGoogle Scholar
  • 9 Kröger K, Berg C, Santosa F. et al Amputationen der unteren Extremität in Deutschland. Dtsch Arztebl Int 2017; 114: 130-136 . doi:10.3238/arztebl.2017.0130
    PubMedGoogle Scholar
  • 10 Bohn B, Grünerbel A, Altmeier M. et al Diabetic foot syndrome in patients with diabetes. A multicenter German/Austrian DPV analysis on 33 870 patients. Diabetes Metab Res Rev 2018; 34 (06) e3020 . doi:10.1002/dmrr.3020
    CrossrefPubMedGoogle Scholar
  • 11 Game FL, Hinchcliffe RJ, Apelquist J. et al. A systematic review of interventions to enhance the healing of chronic foot ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012; 28: 119-141
    CrossrefPubMedGoogle Scholar
  • 12 Mills JL, Conte MS, Armstrong DG. et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WifI). Vasc Surg 2014; 59: 220-234
    CrossrefPubMedGoogle Scholar
  • 13 Conte S, Bradbury AW, Kolh P. et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg 2019; 59 (01) S1-S109
    CrossrefPubMedGoogle Scholar
  • 14 Schade J, Goerig C, Geisbüsch P. Diabetisches Fußsyndrom – gefäßchirurgische Aspekte und Herausforderungen. Diabetologe 2020; 16: 349-354
    CrossrefPubMedGoogle Scholar
  • 15 Elgzyri T, Larsson J, Nyberg P. et al. Early revascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes. Eur J Vasc Endovasc Surg 2014; 48: 440
    CrossrefPubMedGoogle Scholar
  • 16 Butt T, Lilja E, Elgzyri T. et al Amputation free survival in patients with diabetic foot ulcer and peripheral arterial disease: Endovascular versus open surgery in a propensity score adjusted analysis. J Diabetes Complicat 2020; 34 (05) 107551 . Im Internet (Stand: 29.09.2020): https://doi.org/10.1016/j.jdiacomp.2020.107551
    CrossrefPubMedGoogle Scholar
  • 17 Reinecke H, Unrath M, Freisinger E. et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. EurHeart J 2015; 36: 932-938
    CrossrefPubMedGoogle Scholar
  • 18 Malyar NM, Freisinger E, Meyborg M. et al. Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complicat 2016; 30 (06) 1117-1122
    CrossrefPubMedGoogle Scholar
  • 19 Lobmann R, Rümenapf G, Lawall H. et al. Diabetischer Fuß. Beispiel für sektorenübergreifende Versorgungsstrukturen. Diabetologe 2017; 13: 8-13
    CrossrefPubMedGoogle Scholar