nach oben

Zeitschrift für Gerontologie und Geriatrie

Erschienen in:

01.06.2010 | Übersicht

Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten

verfasst von: Dr. C. Ploenes, H. Görtz, T. Heimig, M. Meisel, C. Naumann, R. Sultzer

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 3/2010

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Prävalenz der peripheren arteriellen Verschlusskrankheit (PAVK) im Alter ist hoch, die klinische Manifestation oft untypisch und die Begleit- und Folgemorbidität erheblich. Dies begründet das Erfordernis einer Basisdiagnostik bei dieser Patientengruppe. Gestützt auf eine Literaturrecherche wurden evidenzbasierte Empfehlungen formuliert. Obligater Bestandteil der Primärdiagnostik sind Pulspalpation und Anamneseerhebung auch dann, wenn typische Beschwerden fehlen. Bei pathologischen und nicht verwertbaren Befunden sollte als nächster Schritt eine Doppler-Knöcheldruckmessung durchgeführt werden. Folgende Faktoren bestimmen das weitere Vorgehen: das Vorliegen von Wunden an dem durchblutungsgestörten Bein, insbesondere im Fuß- und Unterschenkelbereich, das Ausmaß PAVK-bedingter Beschwerden, schließlich geplante operative Eingriffe am betroffenen Bein aus anderen Gründen.

Vorheriger Artikel Posturale Defizite und Sturzrisiko bei älteren Personen mit Verdacht auf Osteoporose

Nächster Artikel Entwicklung eines neuen Depressionsscreenings für den Einsatz in der Geriatrie

Al Zahrani HA, Al Bar HM, Bagnassi A, Abdulaal AA (1997) The distribution of peripheral arterial disease in a defined population of elderly high-risk Saudi patients. Int Angiol 16(2):123–128

Barzilay JI, Spiekerman CF, Kuller LH et al (2001) Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diabetes care 24(7):1233–1239CrossRefPubMed

Bickel H, Gradinger R, Kochs E et al (2004) Incidence and risk factors of delirium after hip surgery. Psychiatr Prax 31(7):360–365CrossRefPubMed

Bird CE, Criqui MH, Fronek A et al (1999) Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing. Vasc Med 4(1):15–21CrossRefPubMed

Brearley S, Shearman CP, Simms MH (1992) Peripheral pulse palpation: an unreliable sign. Ann R Coll Surg Engl 74(3):169–171PubMed

Christensen JH, Freundlich M, Jacobsen BA, Falstie-Jensen N (1999) Clinical relevance of pedal oulse palpation in patients suspected of peripheral arterial insufficiency. J Intern Med 226(2):95–99

Coni N, Tennison B, Troup M (1992) Prevalence of lower extremity arterial disease among elderly people in the community. Br J Pract 42(357):149–152

Criqui MH, Coughlin SS, Fronek A (1985) Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study. Circulation 72(4):768–773PubMed

Criqui MH, Fronek A, Klauber MR et al (1985) The sensitivity, specificity and predictive value of traditional clinical evaluation of peripheral arterial disease: results from non-invasive testing in a defined population. Circulation 71:516–522PubMed

10.

Criqui MH, Fronek A, Klauber MR et al (1985) The prevalence of peripheral arterial disease in a defined population. Circulation 71(3):510–516PubMed

11.

Deutsche Gesellschaft für Angiologie, Gesellschaft für Gefäßmedizin (2001) Leitlinien zur Diagnostik und Therapie der arteriellen Verschlusskrankheit der Becken-Beinarterien. Vasa 30 (Suppl 57)

12.

Diamantopoulos EJ, Hild R (1972) Über die Treffsicherheit der Oszillographie und der Pulspalpation auf Grund angiographischer Befunde bei arterieller Verschlusskrankheit. Dtsch Med J 23(5):368–370PubMed

13.

Diehm C, Schuster A, Allenberg JR et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 172(1):95–105CrossRefPubMed

14.

Fowkes FG, Housley E, Cawood EH et al (1991) Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 20:384–392CrossRefPubMed

15.

Friedman SA (1976) Common manifestations of degenerative arterial disease. Med Clin North Am 60(6):1079–1092PubMed

16.

Hänsgen K, Podhaisky H, Preuß EG (1989) Pulstastbefund und nichtinvasiv gemessene Blutdruckwerte der A. tib. post. bei arterieller Verschlusskrankheit. Z Ges Inn Med 44(11):332–334PubMed

17.

Hafner J, Schaad I, Schneider E et al (2000) Leg ulcers in peripheral arterial disease (arterial leg ulcers): impaired wound healing above the treshold of chronic critical limb ischemia. J Am Acad Dermatol 43(6):1001–1008CrossRefPubMed

18.

Hirsch AT, Criqui MH, Treat-Jacobson et al (2001) Peripheral arterial disease detection, awareness and treatment in primary care. JAMA 286(11):1317–1324CrossRefPubMed

19.

Holstein P, Lassen NA (1980) Healing of ulcers on the feet correlated with distal blood presssure measurements in occlusive arterial disease. Acta Orthop Scand 51(6):995–1006CrossRefPubMed

20.

Hooi JD, Kester AD, Stoffers HE et al (2001) Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study. Am J Epidemiol 153(7):666–672CrossRefPubMed

21.

Hooi JD, Stoffers HE, Kester AD et al (2002) Peripheral arterial occlusive disease: prognostic value of signs, symptoms and the ankle-brachial pressure index. Med Decis Making 22(2):99–107PubMed

22.

Kannel WB, McGee DL (1985) Update on some epidemiological features of intermittent claudication: the Framingham study. J Am Geriatr Soc 33(1):13–18PubMed

23.

Katzel LI, Sorkin J, Bradham D, Gardner AW (2000) Comorbidities and the entry of patients with peripheral arterial disease into an exercise rehabilitation program. J Cardiopulm Rehabil 20(3):165–171CrossRefPubMed

24.

Kay TW, Martin FI (1986) Heel ulcers in patients with long-standing diabetes who wear antiembolism stockings. Med J Aust 145(6):290–291PubMed

25.

Lange S, Diehm C, Darius H et al (2004) High prevalence of peripheral arterial disease and low treatment rates in elderly primary care patients with diabetes. Exp Clin Endocrinol Diabetes 112(10):566–573CrossRefPubMed

26.

Leng GC, Fowkes FGR, Lee AJ et al (1996) Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ 313:1440–1443PubMed

27.

Lundin M, Wiksten JP, Perakyla T et al (1999) Distal pulse palpation: is it reliable? World J Surg 23(3):252–255CrossRefPubMed

28.

Martin M, Tenbült L (1985) Result of treatment in 118 foot necroses in relation to ankle blood pressure and diabetes. A one-year retrospective study of 108 patients. Dtsch Med Wochenschr 110(25):989–993CrossRefPubMed

29.

Matzke S, Lepantalo M (2001) Claudication does not always precede critical leg ischemia. Vasc Med 6(2):77–80PubMed

30.

McDermott MM, Criqui MH, Greenland P et al (2004) Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance. J Vasc Surg 39(3):523–530CrossRefPubMed

31.

McDermott MM, Fried L, Simonsick E et al (2000) Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women’s health and aging study. Circulation 101(9):1007–1012PubMed

32.

McGee SR, BoykoEJ (1998) Physical examination and chronic lower-extremity ischemia: a critical review. Arch Intern Med 158(12):1357–1364CrossRefPubMed

33.

Meijer WT, Grobbee DE, Hunink MG et al (2000) Determinants of peripheral arterial disease in the elderly: The Rotterdam study. Arch Intern Med 160(19):2934–2938CrossRefPubMed

34.

Moffatt C, O’Hare L (1995) Ankle pulses are not sufficient to detect impaired arterial circulation in patients with leg ulcers. J Wound Care 4(3):134–138PubMed

35.

Moucka J, Jäger K (1990) Rationelle Abklärung bei peripherer arterieller Verschlusskrankheit. Schweiz Rundsch Med Prax 79(50):1553–1560PubMed

36.

Muller-Bühl U, Engeser P, Klimm HD, Wiesemann A (2003) Quality of life and objective disease criteria in patients with intermittent claudication in general practice. Fam Pract 20(1):36–40CrossRefPubMed

37.

Newman AB, Siscovick DS, Manolio TA et al (1993) Ankle-arm-index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Health Study (CHS) Collaborative Research Group. Circulation 88(3):837–845PubMed

38.

Newman AB, Sutton-Tyrell K, Vogt MT, Kuller LH (1993) Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. JAMA 270(4):497–498CrossRef

39.

Newman AB, Tyrrell KS, Kuller LH (1997) Mortality over four years in SHEP participants with a low ankle-arm index. J Am Geriatr Soc 45(12):1472–1478PubMed

40.

New Zealand Guidelines Group (1999) Care of people with chronic leg ulcers. An evidence based guideline. www.nzgg.org.nz/guidelines/0008/ACF672.pdf

41.

Norton D (1996) Calculating the risk: reflections on the Norton scale. Adv Wound Care 9:38–43PubMed

42.

Ogren M, Hedblad B, Jungquist G et al (1993) Low ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study „Men born in 1914“, Malmo, Sweden. Eur J Vasc Surg 7(5):500–506CrossRefPubMed

43.

Paris BE, Libow LS, Halperin JL, Mulvihill MN (1988) The prevalence and one-year outcome of limb arterial obstructive disease in a nursing home population. J Am Geriatr Soc 36(7):607–612PubMed

44.

Philipps B, Sackett D, Badenoch D et al (2001) Centre of Evidence Based Medicine Oxford http://cebm.net/index.aspx?o=1025

45.

Ploenes CH, Heimig TH, Spamer C et al (2005) Abnormal lower limb pulses in geriatric in-patients. Euro J Ger 7(2):113–116

46.

Resnick HE, Lindsay RS, Mc Dermott MM et al (2004) Relationship of high and low ankle brachial index to all-cause and cardiovascular disease morbidity. The strong heart study. Circulation 109:733–739CrossRefPubMed

47.

Royal college of nursing and national institute for health and clinical excellence (2005) The management of pressure ulcers in primary and secondary care. Final version www.nice.org.uk/nicemedia/pdf/PressureUlcers_Finalscope.pdf

48.

Sasajima Y, Sasajima T, Uchida H et al (2000) Postoperative delirium in patients with chronic lower limb ischaemia: what are the specific markers? Eur J Vasc Endovasc Surg 20(2):32–37CrossRef

49.

Scottish Intercollegiate Guidelines Network (1998) The care of patients with cronic leg ulcer. SIGN Publication Number 26

50.

(n a) (1992) Second European Consensus Document. Eur J Vasc Surg 6 (Suppl A):1–32

51.

Skau T, Jonsson B (1993) Prevalence of symptomatic leg ischemia in a Swedish community – an epidemiological study. Eur J Vasc Surg 7(4):432–437CrossRefPubMed

52.

Stoffers HE, Kester AD, Kaiser V et al (1997) Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice: a multivariate approach. Med Decis Making 17:61–70CrossRefPubMed

53.

Stoffers HE, Rinkens PE, Kester AD et al (1996) The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease. Int J Epidemiol 25(2):282–290CrossRefPubMed

54.

TASC II Inter-Society Consensus on Peripheral Arterial Disease(TASC) (2007). Eur J Vasc Endovasc Surg 33 (Suppl 1):S 24–S 25

55.

Treiman GS, Oderich GS, Ashrafi A, Schneider PA (2000) Management of ischemic heel ulceration and gangrene: an evaluation of factors associated with successful healing. J Vasc Surg 31(6):1110–1118PubMed

56.

Vogt MT, Cauley JA, Kuller LH, Huller SB (1993) Prevalence and correlates of lower extremity arterial disease in elderly women. Am J Epidemiol 137(5):559–568PubMed

57.

Vogt MT, McKenna M, Anderson SJ et al (1993) The relationship between ankle-arm index and mortality in older men und women. J Am Geriatr Soc 41(5):523–530PubMed

58.

Wound Ostomy and Continence Nurses Society (WOCN) (2002) Guideline for management of wounds in patients with lower-extremity arterial disease. WOCN clinical guideline series; no. 1

59.

Yeh ST, Morton DJ, Barrett-Connor E (2000) Lower extremity arterial disease in older women: the Rancho Bernardo Study. J Womens Health Gend Based Med 9(4):373–380CrossRefPubMed

Titel: Evidenzbasierte Empfehlungen zur Basisdiagnostik der peripheren arteriellen Verschlusskrankheit bei geriatrischen Patienten
verfasst von: Dr. C. Ploenes
H. Görtz
T. Heimig
M. Meisel
C. Naumann
R. Sultzer
Publikationsdatum: 01.06.2010
Verlag: Springer-Verlag
Erschienen in: Zeitschrift für Gerontologie und Geriatrie / Ausgabe 3/2010
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI: https://doi.org/10.1007/s00391-009-0051-7

Springerpflege

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2010

Fälle aus dem Grenzgebiet zwischen Geriatrie und Unfallchirurgie

Stellenwert der molekularen Diagnostik bei Alzheimer-Demenz

Frau Prof. Dr. Dr. h. c. mult. Ursula Lehr zum 80. Geburtstag

Einheit in der Vielfalt

Mitteilungen der DGGG

Mitteilungen des BV Geriatrie