Zusammenfassung
Klinisches Problem
Innerhalb der letzten Jahre hat die interventionelle Radiologie das Management des Polytraumas massiv beeinflusst.
Klinisches Problem
Um eine Kontrolle einer arteriellen oder venösen Blutung zu erreichen, können heute nahezu alle Gefäße mithilfe spezieller Katheter und Drähte in kürzester Zeit erreicht werden.
Therapeutisches Standardverfahren/Neue Therapieverfahren
Während früher eine Blutung nur in einem aufwendigen operativen Eingriff kontrolliert werden konnte, stehen heute Methoden zur Verfügung, die Gefäße temporär zu okkludieren (Okklusionsballon), zu embolisieren oder mittels Stent zu schienen.
Diagnostik
Speziell beim Polytrauma wird die Planung dieser Eingriffe wann immer möglich nach einem präinterventionellen Multidetektor-CT durchgeführt.
Leistungsfähigkeit
Der Einsatz der endovaskulären Intervention ermöglicht neben einer Verringerung des operativen Traumas auch eine wesentliche Verkürzung der Behandlungszeit.
Bewertung
Beim vaskulären Trauma am Stamm oder an den Extremitäten, wo ein operativer Zugang nur unter erhöhtem Risiko durchführbar erscheint, aber auch beim pelvinen Trauma und bei arteriellen Verletzungen parenchymatöser Organe, die nicht gänzlich geopfert werden sollen, sowie in anderen schwer zugänglichen Regionen wie der oberen Thoraxapertur, ist die interventionelle Versorgung mittlerweile Standardmethode geworden.
Empfehlung für die Praxis
Heute kann die interventionelle Radiologie in praktisch allen vaskulären Territorien in einem interdisziplinären Zugang neben der offenen chirurgischen Versorgung dazu beitragen, eine schnellere Stabilisierung der Situation herbeizuführen.
Abstract
Clinical issue
In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding.
Standard treatment/treatment innovations
Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting.
Diagnostic work-up
In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible.
Performance
Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time.
Achievements
Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods.
Practical recommendations
In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access.
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Interessenkonflikt. M. Funovics und C. Kinstner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Kinstner, C., Funovics, M. Endovaskuläre Interventionen beim Polytrauma. Radiologe 54, 893–899 (2014). https://doi.org/10.1007/s00117-013-2638-7
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DOI: https://doi.org/10.1007/s00117-013-2638-7