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Algorithmus der präoperativen kardiovaskulären Diagnostik vor gefäßmedizinischen Eingriffen

Algorithm of preoperative cardiovascular diagnostics before vascular surgery

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Zusammenfassung

In der Chirurgie/Gefäßchirurgie werden zunehmend multimorbide Patienten therapiert. Zum perioperativen Management vor nichtkardialen Operationen wurde 2022 eine Leitlinie der europäischen Gesellschaft für Kardiologie publiziert. Die Handlungsempfehlungen, mit besonderem Augenmerk auf gefäßchirurgische Patienten, werden hier zusammengefasst.

Präoperativ soll das individuelle Patienten- und Operationsrisiko evaluiert werden. Basierend auf diesen Faktoren erfolgt ein entsprechendes Risikoassessment und die Patienten durchlaufen einen Diagnostikalgorithmus. Neu ist die Empfehlung kardiale Biomarker vor Mittel- und Hochrisikooperationen bei Patienten ab 65 Lebensjahre oder mit entsprechenden Risikofaktoren und Vorerkrankungen durchzuführen. So wird frühzeitig in einer Hochrisikopopulation eine perioperative myokardiale Schädigung diagnostiziert. Die entsprechende Therapie soll die perioperative Mortalität senken. Gerade in der Gefäßchirurgie stellen die Patienten mit ihren atherosklerotischen Grunderkrankungen als Multisystemerkrankung große Herausforderungen an die perioperative Therapie und Diagnostik.

Abstract

Patients with multimorbidities are increasingly being treated by surgery/vascular surgery. A guideline on perioperative management prior to non-cardiac surgery was published by the European Society of Cardiology in 2022. The recommendations, with a focus on vascular surgery patients, are summarised here.

The individual patient and surgical risk should be evaluated preoperatively. Based on these factors, a corresponding risk assessment is carried out and the patients undergo a diagnostic algorithm. A new recommendation is to screen cardiac biomarkers before medium- and high-risk operations in patients aged 65 or over, or with specific cardiovascular risk factors or diseases. Therefore, perioperative myocardial damage is diagnosed early in a high-risk population. The appropriate therapy should reduce perioperative mortality. In vascular surgery in particular, patients with underlying atherosclerotic disease represent major challenges for perioperative therapy and diagnostics.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland

    Jan David Süss &  Michael Gawenda

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„Kommission perioperative Medizin“ der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin

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Correspondence to Jan David Süss.

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J. D. Süss und M. Gawenda geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Süss, J.D., Gawenda, M. & „Kommission perioperative Medizin“ der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin. Algorithmus der präoperativen kardiovaskulären Diagnostik vor gefäßmedizinischen Eingriffen. Gefässchirurgie 29, 217–224 (2024). https://doi.org/10.1007/s00772-024-01102-y

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