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Phlebologische Notfälle

Phlebological emergencies

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Zusammenfassung

Hintergrund

Tiefe und oberflächliche Venenthrombosen sowie Varizenblutungen sind phlebologische Notfälle. Bei Venenthrombosen ist das Risiko für kurz- und langfristige Morbidität und Mortalität erhöht. Die Varizenblutung birgt die Gefahr massiver Blutverluste. Eine rasche und adäquate Therapie dieser Erkrankungen ist daher essenziell.

Ziel der Arbeit

Ziel unserer Arbeit war es, einen Überblick über diese phlebologischen Notfälle zu geben.

Material und Methoden

Basierend auf den aktuellen Leitlinien und ergänzt durch eine themenspezifische Literaturrecherche in PubMed fassen wir die für die klinische Praxis wichtigsten Aspekte zusammen.

Ergebnisse

Bei einer tiefen Venenthrombose sind eine therapeutische Antikoagulation und Kompressionstherapie über mindestens 3 bis 6 Monate indiziert. Eine kürzere Therapiedauer geht mit einer deutlich erhöhten Rezidivrate einher. Bei oberflächlicher Venenthrombose stellen Mobilisation, Kühlung und Kompression sowie bei Schmerzen nichtsteroidale Antiphlogistika die Basistherapie dar. Länge des Thrombus und Abstand des proximalen Thrombusteils zum tiefen Venensystem sowie Vorliegen von Risikofaktoren sind entscheidend für die Indikation zur Antikoagulation und deren Dosierung. Die Varizenblutung ist eine Komplikation der fortgeschrittenen Varikose und kann meist mit einfachen Maßnahmen wie Hochlagerung des Beins und Kompression beherrscht werden.

Fazit

Bei oberflächlicher und tiefer Venenthrombose sind die frühe Diagnostik und Therapie essenziell, um akut Komplikationen wie Lungenembolie und Thrombuswachstum und Spätkomplikationen wie das postthrombotische Syndrom mit sekundärer Varikose und Ulcus cruris zu vermeiden. Zur Rezidivprophylaxe ist bei Varikophlebitis und Varizenblutung im Verlauf eine Sanierung der Varikose indiziert.

Abstract

Background

Deep and superficial vein thromboses as well as variceal hemorrhages are emergencies. The risk of short- and long-term morbidity and mortality in vein thromboses is increased. Variceal hemorrhage harbors the risk of massive blood loss. Prompt and adequate therapy of these diseases is therefore essential.

Objectives

Our aim was to give an overview of these phlebological emergencies.

Materials and methods

Based on the current guidelines and supplemented by a selective literature search in PubMed, we summarize the most important aspects for clinical practice.

Results

In deep vein thrombosis, therapeutic anticoagulation and compression therapy are indicated for a duration of at least 3–6 months. A shorter duration is associated with a considerably increased recurrence rate. Basic measures in superficial vein thrombosis comprise mobilization, cooling, and compression. In case of tenderness on palpation, non-steroidal anti-inflammatory drugs are recommended. Indication for anticoagulation and its dose depends on length of the thrombus and distance of the proximal part of the thrombus towards the deep veins. Variceal hemorrhage is a complication of advanced varicosis and can usually be handled with simple measures such as elevation of the extremity and compression.

Conclusions

Prompt diagnosis and therapy is essential in superficial and deep vein thrombosis to prevent short-term complications such as pulmonary embolism and growth of the thrombus as well as long-term complications such as postthrombotic syndrome with secondary varicosis and chronic leg ulcer. After the occurrence of varicophlebitis or variceal hemorrhage, treatment of varicosis is indicated to prevent recurrences.

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Authors and Affiliations

  1. Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland

    L. I. Gonser &  A. Strölin

  2. Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland

    C. E. Gonser

Authors
  1. L. I. Gonser
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  2. C. E. Gonser
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  3. A. Strölin
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Correspondence to A. Strölin.

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Interessenkonflikt

L.I. Gonser, C.E. Gonser und A. Strölin geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gonser, L.I., Gonser, C.E. & Strölin, A. Phlebologische Notfälle. Hautarzt 69, 384–391 (2018). https://doi.org/10.1007/s00105-018-4160-3

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