Deutsche medizinische Wochenschrift
-
Peripheral arterial disease (PAD) is considered a marker disease of multi-locular atherosclerosis and is associated with a high risk of cardiovascular events. PAD is both underdiagnosed and undertreated in everyday clinical practice. The disease is often asymptomatic and is often only diagnosed at an advanced stage, especially in diabetics. Therefore, the early diagnosis of PAD is of central importance to provide patients with stage-appropriate therapy at an early stage.
-
The surgical treatment of peripheral arterial occlusive disease focuses not only on the direct restoration of the femoral bifurcation but also on the peripheral bypass, especially in the case of chronic amputation-threatening ischemia. Comprehensive imaging is indispensable for planning surgical therapy. The local reconstruction of the femoral bifurcation offers very good long-term results and can be easily combined with endovascular methods. ⋯ The technical limit for a bypass system lies in the pedal arteries and their branches. These methods can be combined with upstream and downstream endovascular interventions in the form of a hybrid intervention. Surgical and endovascular interventions are to be considered as complementary.
-
Dtsch. Med. Wochenschr. · Oct 2023
[Provision planning at the end of life from a legal point of view].
In the event of the loss of the ability to give consent and thus the possibility of legally validating one's own will, the law regularly provides for a mandatory third-party representation for the patient. However, their design can be influenced preventively, for which purpose those affected are given three options. These options are: patient's decree, health Power of Attorney, guardianship order. ⋯ The written form of the advance directives forms an objective basis for mutual control of future decision-makers in the event of questions of interpretation. Absolute certainty that the current will of the patient corresponds to the future and that it is reliably determined and implemented in the decision-making situation is not possible. Nevertheless, the task is to come as close as possible to this ideal image in clinical reality.
-
Dtsch. Med. Wochenschr. · Oct 2023
[Precautionary planning at the end of life from the perspective of intensive care medicine].
In recent years, the number of intensive care treatments has increased significantly. About every fourth patient who dies in hospital receives intensive care. Structured prevention planning is important in order to implement the patient's wishes in situations of serious illness in which patients cannot express their wishes themselves. ⋯ Communication of the prognosis and the prognostic uncertainty is therefore crucial in order to determine the presumed will of the patient, especially in the context of the process of weighing up the benefits and burdens of intensive care therapies. Hospital treatment can be the reason for targeted preventive planning and avoid unnecessary intensive care treatment during the same stay. Documentation templates can help to record the results of preventive care planning clearly and comprehensibly in the medical file.
-
Today, peripheral artery disease (PAD) is treated with the most modern endovascular and open surgical revascularisation procedures. But the short and long-term success of these interventions is decisively determined by the conservative therapy of PAD, which therefore represents the absolute basic therapy of every PAD. ⋯ This paper presents the spectrum of both drug and non-drug strategies and focuses on aspects such as platelet inhibition and anticoagulation regimes, lipid-lowering options as well as the benefits and necessity of exercise programs to promote collaterals and improve quality of life by extending the pain-free walking distance. Proven strategies to overcome smoking addiction, use and purpose of vasoactive substances are highlighted as well as the potential risks of diabetic foot syndrome for limb salvage and prevention of wounds.