Die Extremitätenischämie bei Ausdauersportlern

 

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Zusammenfassung

Der ischämische Muskelschmerz bei Ausdauersportlern ist eine oft vergessene Differenzialdiagnose des belastungsinduzierten Extremitätenschmerzes. Die meist unspezifische Beschwerdesymptomatik sowie die vielen möglichen Differentialdiagnosen machen sie zu einer interdisziplinären Herausforderung. Klinisch manifestieren sich die genannten Gefäßveränderungen als Oberschenkel- und Wadenschmerzen bei Belastung oder als akute Ischämie beim plötzlichen arteriellen Verschluss. Die Anamnese sowie klinische Untersuchung zählen zu den wichtigsten Diagnosegrundlagen. Als weitere, nicht invasive Untersuchungen sind die Bestimmung des Knöchel-Arm-Dopplerindex sowie die Duplexsonographie zu nennen. Weiterführende Diagnostika sind die Schnittbildverfahren Computertomographische Angiographie (CTA) und die Magnetresonanz-Angiographie (MRA). Die Digitale Subtraktionsangiographie (DSA) als invasive Diagnostik stellt das Lumen in hoher Auflösung dar, wird aber meist erst nach Schnittbilduntersuchung in Kombination mit interventioneller Therapie (z. B. Ballonangioplastie oder intraarterielle Lysetherapie) verwendet. Goldstandard der Therapie ist die operative Korrektur, wodurch der Athlet am schnellsten zu seinem ursprünglichen Trainingszustand zurückfindet. Bei arteriell bedingten Extremitätenschmerzen des Ausdauersportlers ist die rasche Diagnosestellung prognostisch entscheidend. Die Erhebung des peripheren Pulsstatus sowie die Bestimmung des Knöchel-Arm-Dopplerindex vor und nach Belastung sind einfach durchführbar und oft wegweisend.

Abstract

Lower extremity pain due to acute or chronic ischemia in high performance endurance athletes is an often forgotten differential diagnosis. A variety of symptoms constitues a multi-disciplinary challenge. Intermittent claudication or acute ischemia are clinical symptoms indicative of this vascular disease. The most important basic methods of investigation are anamnesis and clinical examination. Furthermore, the determination of the ankle-brachial index (ABI) and duplexsonography should be considered. In addition, modern cross-sectional imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are recommended. In case of suspect findings, the digital substraction angiography (DSA) represents a high resolution image technique for illustration of the vessel lumen. If necessary, interventional therapy (balloon angioplasty or clot lysing) can be performed simultaneously. Surgical revision remains the gold-standard of therapy and the fastest way in which athletes regain maximum performance abilities. Correct diagnosis of lower limb ischemia affecting endurance athletes should be performed without delays. Determining the ankle-brachial index following maximal exertion represents the most important diagnostic tool. Surgical treatment techniques as decompression and revascularisation provide the best long-term results.

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