Shunt-induzierte Handischämie

Fazit und Ausblick

Die Therapie der Shunt-induzierten Handischämie wird zukünftig eine zunehmende Bedeutung erfahren. Der Anstieg der Anzahl älterer Hämodialysepatienten mit einem höheren Anteil an Diabetikern wird vermehrt Patienten mit Risikofaktoren für eine Shunt-induzierte Handischämie bedingen (proximal gelegene Anastomose, vorbestehende Gefäßveränderungen). Einheitliche Empfehlungen zur Wahl des Behandlungsverfahrens können nicht gegeben werden. Auch die DRIL-Prozedur, die oftmals in der neueren Literatur als Standardverfahren propagiert wird, ist nur Teil eines Armamentariums der Therapie der Shunt-induzierten Handischämie. Entscheidend für die Wahl des Therapieverfahrens ist das Erkennen der individuell bei den einzelnen Patienten zugrunde liegenden Pathomechanismen der Shunt-induzierten Handischämie. Faktoren wie die geschätzte Lebenserwartung des Patienten und die Beeinflussung der Lebensqualität durch das Operationsverfahren sollten bei der Indikationsstellung Berücksichtigung finden. Technische Weiterentwicklungen bei der Identifizierung und Überwachung der hämodynamischen Veränderungen nach Anlage eines arteriovenösen Shunt werden das Verständnis der Ätiologie der Shunt-induzierten Handischämie erweitern, die differenzierte Verfahrenswahl zur Therapie der Shunt-induzierten Handischämie unterstützen und den zu erwartenden Einfluss auf die Symptombeseitigung und den Shunt-Erhalt besser abschätzen lassen. Sicherlich gehört die Behandlung der Shunt-induzierten Handischämie in die Hand des erfahrenen Shunt-Chirurgen, da die Qualität der von ihm durchgeführten Maßnahmen das Outcome des Hämodialysepatienten wesentlich beeinflussen kann.

• Literatur

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