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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2013; 07(04): 229-235
DOI: 10.1055/s-0037-1618824
Übersichtsarbeit
Schattauer GmbH

Erkrankungen des arteriellen und venösen Gefäßsystems beim adipösen Patienten

Bedeutung für die GefäßchirurgieVenous and non-cardiac arterial disease in obese patients.Importance for vascular surgery
P.T. Fellmer
1   Universitätsklinikum Leipzig, Department für operative Medizin, Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie
,
I. Matia
1   Universitätsklinikum Leipzig, Department für operative Medizin, Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie
,
F. Krenzien
1   Universitätsklinikum Leipzig, Department für operative Medizin, Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie
,
M. Moche
2   Universiätsklinikum Leipzig, Department für Bildgebung und Strahlenmedizin, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie
,
S. Jonas
1   Universitätsklinikum Leipzig, Department für operative Medizin, Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie
› Author Affiliations
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Publication History

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Übergewicht ist ein bekannter Risikofaktor für die Genese kardiovaskulärer Erkrankungen. Eine Korrelation mit früh nachzuweisenden Arterioskleroseprädiktoren legt ebenfalls einen Zusammenhang mit nicht kardialen vaskulären Erkrankungen nahe. Für den Gefäßchirurgen sind daher die Auswirkungen auf typische Krankheitsbilder, wie dem Bauch aortenaneurysma, der peripheren arteriellen Verschlusskrankheit und der Insuffizienz des oberflächlichen venösen Systems von Bedeutung. Die Literatur zeigt jedoch deutliche Inhomogenitäten aber auch teilweise nicht vermutete Zusammenhänge zwischen Übergewicht und diesen Erkrankungen. Insbesondere die postoperativen Ergebnisse sowohl im Kurz- als auch im Langzeitverlauf unterliegen häufig dem sogenannten “Obesity Paradoxon”, einem noch weitgehend ungeklärten Zusammenhang zwischen Adipositas und positive postoperativen Ergebnissen in der Gefäßchirurgie. Einzig der lineare Anstieg von postoperativen Wundheilungsstörungen im Verhältnis zum BMI lässt sich wie erwartet aus großen Studien ableiten. Eine abschließende Herausforderung für die Gefäßchirurgie verbleibt die Versorgung adipöser Dialysepatienten mit geeigneten und dauerhaften arteriovenösen Gefäßzugängen.

Summary

Obesity is a known risk factor for the development of cardiovascular disease. Early evidence suggests that arteriosclerosis is connected with non-cardiac vascular disease. Thus, the impact of obesity on vascular surgery associated diseases is important. The literature shows inconsistent results, but suspects links between obesity and peripheral arterial disease, aortic aneurysm, and insufficiency of the superficial venous system. In particular, both short- and long-term postoperative results often display the so-called “obesity paradox”. A still unexplained association between obesity and positive postoperative outcome in vascular surgery. Only the linear increase of surgical site infection with increasing BMI, as expected, can be seen in large studies. A final challenge for the vascular surgeon is the establishment of permanent arterio-venous vascular access in obese dialysis patients.

Schlüsselwörter

Adipositas - Gefäßchirurgie - venöse Erkrankungen - arterielle Erkrankungen

Keywords

Obesity - vascular surgery - venous disease - arteriosclerosis
 

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