Die Besonderheit von Gefäßverletzungen nach Sportunfällen - eine seltene, aber ernst zu nehmende Komplikation

 

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Zusammenfassung

In Deutschland treten pro Jahr häufiger Sportverletzungen als Verletzungen im Straßenverkehr mit Personenfolge auf. Über Gefäßverletzungen beim Sportunfall sind keine genaue Zahlen bekannt, Veröffentlichungen zu diesem Thema sind meist kasuistisch. In einer retrospektiven Untersuchung wurden 216 Gefäßverletzungen aus den Jahren 1987 bis 1996 ausgewertet, wobei nur 6 Gefäßverletzungen bei Sportunfällen auftraten. Während in 3 Fällen der Organerhalt durch die Gefäßrekonstruktion möglich war, erfolgte 2-mal die Organresektion, in einem Fall war die konservative Therapie erfolgreich. Gefäßverletzungen nach Sportunfällen sind meist durch einen stumpfen Verletzungsmechanismus verursacht. Bei einer äußeren Blutung wird ohne Zeitverzögerung durch zusätzliche Diagnostik die sofortige Operation durchgeführt. Bei inkompletter oder verzögert auftretender Ischämie durch einen stumpfen Verletzungsmechanismus kann die Diagnosestellung erschwert sein. Die apparative Diagnostik stützt sich im Wesentlichen auf cw-Doppler-Sonographie und Duplex-Sonographie und später die Angiographie. Die Wiederherstellung der Strombahn muss bei nutritiven Gefäßen innerhalb der Ischämietoleranzzeit (6-8 Stunden) erfolgen. Bei verzögerter Gefäßrekonstruktion besteht die Gefahr des Reperfusionsschadens.

Abstract

There are about 1.5 million sports injuries in Germany every year, but concomitant vascular injuries are rarely encountered. Only single cases have been reported in the literature. The records of 216 patients with vascular injuries who were admitted to the university hospital in Jena between 1987 and 1996 were retrospectively reviewed. Six patients sustained a vascular injury during the accident in different kinds of sport. Vascular repair was successfully performed in three cases. Organ resection was necessary in two cases and one patient was treated conservatively. Most vascular lesions are related to blunt trauma which might create delayed symptoms of ischemia. Therefore measurement of limb pressures, Doppler scan, duplex ultrasonography and angiography are adjuncts in patients evaluation. In case of bleeding or complete ischemia the prompt arterial reconstruction is indicated and subsequently minimizes the risk of reperfusion injury.

Literatur

• 1 Abraham P, Saumet J L, Chevalier J M. External iliac artery endofibrosis in athletes.  Sports Med. 1997;  24 221-226
  PubMedGoogle Scholar
• 2 Balaji M R, DeWeese J A. Adductor canal outlet syndrome.  JAMA. 1981;  245 167-170
  CrossrefPubMedGoogle Scholar
• 3 Bandyk D F. Vascular injury associated with extremity trauma.  Clin Orthop. 1995;  318 117-124
  PubMedGoogle Scholar
• 4 Berkovich G Y, Ramchandani P, Preate D L, Rovner E S, Shapiro M B, Banner M P. Renal vein thrombosis after martial arts trauma.  J Trauma. 2001;  50 144-145
  CrossrefPubMedGoogle Scholar
• 5 Böhles H. Radikalerkrankungen - Die Bedeutung von Sauerstoffradikalen für die klinische Medizin.  Z Geriartrie. 1991;  4 358-372
  PubMedGoogle Scholar
• 6 Bulkey G B, Schiller H J, Andreoni K A. Free radicals ablation therapy-prevention of postischemic renal failure following renal transplantation.  Klin Wochenschr. 1991;  69 1083-1094
  CrossrefPubMedGoogle Scholar
• 7 Busconi B D, Morgan W J. Acute digital ischemia in a body builder.  Orthopedics. 1989;  21 85-86
  PubMedGoogle Scholar
• 8 Bynoe R P, Miles W S, Bell R M, Greenwold D R, Sessions G, Haynes J L, Rush D S. Noninvasive diagnosis of vascular trauma by duplex ultrasonography.  J Vasc Surg. 1993;  14 346-352
  PubMedGoogle Scholar
• 9 Caiati J M, Masters C M, Todd E J, Benvenisty A I, Todd G J. Symptomatic axillary artery dissection in a tennis player. Case report.  Am J Sports Med. 2000;  28 411-412
  PubMedGoogle Scholar
• 10 Dennis J W, Frykberg E R, Veldenz H C, Huffman S, Menawat S S. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5- to 10-year follow-up.  J Trauma. 1998;  44 243-252
  PubMedGoogle Scholar
• 11 Dennis J W, Jagger C, Butcher J L, Menawat S S, Neel M, Frykberg E R. Reassessing the role of arteriograms in the management of posterior knee dislocations.  J Trauma. 1993;  35 692-695
  CrossrefPubMedGoogle Scholar
• 12 Ertel W, Trentz O. Polytrauma und Multiorgan-Dysfunktionssyndrom (MODS) Definition-Pathophysiologie-Therapie.  Zentralbl Chir. 1994;  119 159-167
  PubMedGoogle Scholar
• 13 Finkelstein J A, Johnston K W. Thrombosis of the axillary artery secondary to compression by the pectoralis minor muscle.  Ann Vasc Surg. 1993;  7 287-290
  PubMedGoogle Scholar
• 14 Francis H, Thal E R, Weigelt J A, Redman H C. Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?.  J Trauma. 1991;  31 512-514
  PubMedGoogle Scholar
• 15 Friedman R J, Jupiter J B. Vascular injuries and closed extremity fractures in children.  Clin Orthop. 1984;  188 112-119
  PubMedGoogle Scholar
• 16 Fry W R, Smith R S, Sayers D V, Henderson V J, Morabito D J, Tsoi E K, Harness J K, Organ C H. The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma.  Arch Surg. 1993;  128 1368-1372
  CrossrefPubMedGoogle Scholar
• 17 Frykberg E R, Crump J M, Vines F S, McLellan G L, Dennis J W, Brunner R G, Alexander R H. A reassessment of the role of arteriography in penetrating proximity extremity trauma: a prospective study.  J Trauma. 1989;  29 1041-1050
  PubMedGoogle Scholar
• 18 Giardino R, Giavaresi G, Fini M, Torricelli P, Guzzardella G A. The role of different chemical modifications of superoxide dismutase in preventing a prolonged muscular ischemia/reperfusion injury.  Artif Cells Blood Substit Immobil Biotechnol. 2002;  30 189-198
  PubMedGoogle Scholar
• 19 Green A, Allen B L. Vascular injuries associated with dislocation of the knee.  J Bone Joint Surg. 1977;  59 236-239
  PubMedGoogle Scholar
• 20 Guiral J, Acosta J P, De Benito J I. Acute compartment syndrome as a complication of a distal forearm fracture: apropos of a case of a child.  Rev Chir Orthop Reparatrice Appar Mot. 1995;  81 449-452
  PubMedGoogle Scholar
• 21 Guvener M, Guvener M, Kaplan S, Demircin M, Pasaoglu I. Axillary artery injury: an isolated, delayed case after blunt trauma of the upper limb.  J Trauma. 2000;  48 951-953
  CrossrefPubMedGoogle Scholar
• 22 Hainline B. Semi-pro football player who suffered a cerebral vascular accident following forced cervical flexion and subsequent spinal manipulation.  Med Sci Sports Exerc. 1992;  24 1066
  PubMedGoogle Scholar
• 23 Hardy J H, Duncan W L, Anderson L D. Vascular insufficiency with football injuries about the knee. Report of three cases.  Am Surg. 1966;  32 155-160
  PubMedGoogle Scholar
• 24 Harkin D W, Kirk G, Clements W D. Abdominal aortic rupture in a child after blunt trauma on a soccer field.  Injury. 1999;  30 303-334
  CrossrefPubMedGoogle Scholar
• 25 Hoover N W. Injury of the popliteal artery associated with dislocation of the knee.  Clin Orthop Rel Res. 1991;  263 200-205
  PubMedGoogle Scholar
• 26 Johansen K, Lynch K, Paun M, Copass M. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities.  J Trauma. 1991;  31 515-519
  CrossrefPubMedGoogle Scholar
• 27 Kee S T, Dake M D, Wolfe-Johnson B, Semba C P, Zarins C K, Olcott C.. Ischemia of the throwing hand in major league baseball pitchers: embolic occlusion from aneurysms of axillary artery branches.  J Vasc Interv Radiol. 1995;  6 979-982
  PubMedGoogle Scholar
• 28 King J W, Brelsford H J, Tullos H. Analysis of the pitching arm of the professional baseball pitcher.  Clin Orthop. 1969;  67 116-123
  PubMedGoogle Scholar
• 29 Kioumehr F, Yaghmai I, Bakody P. Delayed common femoral artery stenosis due to blunt trauma.  Can Assoc Radiol J. 1989;  40 324-325
  PubMedGoogle Scholar
• 30 Lee A W, Hopkins S F, Griffen W O. Axillary artery aneurysm as an occult source of emboli to the upper extremity.  Am Surg. 1987;  53 485-486
  PubMedGoogle Scholar
• 31 Markant A, Rimbach G, Krämer K, Myer H, Pallauf J. Reaktive Sauerstoffradikale: Entstehung, Wirkung, Eliminierung.  PZ. 1995;  26
  PubMedGoogle Scholar
• 32 Markgraf E, Böhm B, Bartel M, Dorow C, Rimpler H, Friedel R. Traumatische periphere Gefäßverletzungen.  Unfallchirurg. 1998;  101 1-12
  CrossrefPubMedGoogle Scholar
• 33 Markgraf E, Clausner G, Lungershausen W. Traumatic vascular lesions of the knee joint.  Beitr Orthop Traumatol. 1989;  36 401-411
  PubMedGoogle Scholar
• 34 McCarthy W J, Yao J S, Schafer M F, Nuber G, Flinn W R, Blackburn D, Suker J R. Upper extremity arterial injury in athletes.  J Vasc Surg. 1989;  9 317-327
  PubMedGoogle Scholar
• 35 Menke W. Kompendium der Sportverletzungen. Kilian, Marburg 2000; 9-10
  Google Scholar
• 36 Mosimann F, Walder J, Van Melle G. Stenotic intimal thickening of the external iliac artery. Illness of competition cyclists.  Vascular Surgery. 1985;  19 58-63
  PubMedGoogle Scholar
• 37 Neuburg-Heusler D, Hennerici M. Gefäßdiagnostik mit Ultraschall. Georg Thieme, Stuttgart New York 1995
  Google Scholar
• 38 Novelli G P, Adembri C, Gandini E, Orlandi S Z, Papucci L, Formigli L, Mannecheschi L I, Quattrone A, Pratesi C, Capaccioli S. Vitamin E protects human skeletal muscle from damage during surgical ischemia-reperfusion.  The Am Journal of Surg. 1997;  173 206-209
  PubMedGoogle Scholar
• 39 Nuber G W, McCarthy W J, Yao J S, Schafer M F, Suker J R. Arterial abnormalities of the shoulder in athletes.  Am J Sports Med. 1990;  18 514-519
  PubMedGoogle Scholar
• 40 Oestern H J, Tscherne H. Mehrfachverletzungen. In: Heberer G, Köle W, Tscherne H (Hrsg). Mehrfachverletzungen. Springer, Berlin Heidelberg New York 1993: 969-974
  Google Scholar
• 41 Putukian M, McKeag D B, Nogle S. Noncontact knee dislocation in a female basketball player: a case report.  Clin J Sport Med. 1995;  5 258-261
  PubMedGoogle Scholar
• 42 Reekers J A, den Hartog B M, Kuyper C F, Kromhout J G, Peeters F L. Traumatic aneurysm of the posterior circumflex humeral artery: a volleyball player's disease?.  J Vasc Interv Radiol. 1993;  4 405-408
  PubMedGoogle Scholar
• 43 Reess J, Pfandl S, Pfeifer T, Kornhuber H H. Traumatic occlusion of the internal carotid artery as an injury sequela of soccer.  Sportverletz Sportschaden. 1993;  7 88-89
  Article in Thieme ConnectPubMedGoogle Scholar
• 44 Rettig A C. Neurovascular injuries in the wrists and hands of athletes.  Clin Sports Med. 1990;  9 389-417
  PubMedGoogle Scholar
• 45 Richter E R, Shriver C D. Delayed nephrectomy in grade V renal injury with two interesting anatomic variations.  Urology. 2001;  58 607
  PubMedGoogle Scholar
• 46 Rohrer M J, Cardullo P A, Pappas A M, Phillips D A, Wheeler H B. Axillary artery compression and thrombosis in throwing athletes.  J Vasc Surg. 1990;  11 761-768
  CrossrefPubMedGoogle Scholar
• 47 Roth J W, Boyd C R. Recreational bicycling and injury to the external iliac artery.  Am Surg. 1999;  65 460-463 (Review)
  PubMedGoogle Scholar
• 48 Rosi G, Pichot O, Bosson J L, Calabrese G, Carpentier P. Echographic and Doppler screening of the forearm arteries in professional volleyball players.  Am J Sports Med. 1992;  20 604-606
  PubMedGoogle Scholar
• 49 Sarfati M R, Galt S W, Treiman G S, Kraiss L W. Common femoral artery injury secondary to bicycle handlebar trauma.  J Vasc Surg. 2002;  35 589-591
  PubMedGoogle Scholar
• 50 Schlickewei W, Kuner E H, Spillner G, Gotze B. Fractures accompanied by injuries of the great vessels in sport and leisure accidents. Diagnosis and management concept.  Radiologe. 1989;  29 554-560
  PubMedGoogle Scholar
• 51 Schneider K, Kasparyan N G, Altchek D W, Fantini G a, Weiland A J. An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher.  The American Journal of Sports Medicine. 1999;  3 370-375
  PubMedGoogle Scholar
• 52 Schoenberg M H, Beger H G. Sauerstoffradikale und postischämische Organschäden-Pathophysiologie, klinische Relevanz und Therapie.  Zentralbl Chir. 1995;  120 174-185
  PubMedGoogle Scholar
• 53 Skudder P A, Gelfand M L, Blumenberg R M, Fulco J. Tibial artery false aneurysm: uncommon result of blunt injury occurring during athletics.  Ann Vasc Surg. 1999;  13 589-591
  CrossrefPubMedGoogle Scholar
• 54 Steinbrück H. Epidemiologie von Sportverletzungen. 15-Jahres-Analyse einer sportorthopädischen Ambulanz.  Sportverletzung/Sportschaden. 1987;  1 2-12
  PubMedGoogle Scholar
• 55 Taylor A J, Tennant W G, Batt M E, Wallace W A. Traumatic occlusion of the external iliac artery in a racing cyclist: a cause of ill defined leg pain.  Br J Sports Med. 1997;  31 155-156
  PubMedGoogle Scholar
• 56 Todd G J, Benvenisty A I, Hershon S, Bigliani L U. Aneurysms of the mid axillary artery in major league baseball pitchers - a report of two cases.  J Vasc Surg. 1998;  28 702-707 (Review)
  PubMedGoogle Scholar
• 57 Topper S M, Berger R A. Radial artery thrombosis in a young athlete. A case report.  Am J Sports Med. 1998;  26 297-299
  PubMedGoogle Scholar
• 58 Tullos H S, Erwin W D, Woods G W, Wukasch D C, Cooley D A, King J W. Unusual lesions of the pitching arm.  Clin Orthop. 1972;  88 169-182
  PubMedGoogle Scholar
• 59 Tytherleigh M G, Charnley G J, Wilkins D C. Closed rupture of the posterior tibial artery secondary to a soccer injury.  Ann R Coll Surg Engl. 1998;  80 266-268
  PubMedGoogle Scholar
• 60 Viswanath Y K, Rogers I M. A non-contact complete knee dislocation with popliteal artery disruption, a rare martial arts injury.  Postgrad Med J. 1999;  75 552-553
  PubMedGoogle Scholar
• 61 Vollmar J. Rekonstruktive Chirurgie der Arterien. Springer, Stuttgart 1996
  Google Scholar
• 62 Weber G, Strauss A L, Rieger H, Scheffler A, Eisenhoffer J. Validation of Doppler measurement of pressure gradients across peripheral model arterial stenosis.  J Vasc Surg. 1992;  16 10-16
  PubMedGoogle Scholar
• 63 Weinstein S M, Herring S A. Nerve problems and compartment syndromes in the hand, wrist, and forearm.  Clin Sports Med. 1992;  11 161-188
  PubMedGoogle Scholar
• 64 Wright I A, Pugh N D, Goodfellow J, Wood A M, Lane I F, Fraser A G. Dynamic obstruction of the external iliac artery in endurance athletes and its relationship to endothelial function: the case of a long distance runner.  Br J Sports Med. 1997;  31 156-158
  PubMedGoogle Scholar

Dr. med. B. Böhm

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Lehrstuhl der Friedrich-Schiller-Universität Jena

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