H. Wenk

Klinikum Bremen-Nord · Department of Surgery

The reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly...

Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of a...

Communication is essential in vascular medicine. Medicine without communication is unthinkable. The computerization of medical devices and the increasing application of artificial intelligence adds new aspects to communication between humans and humans, machines and machines as well as between humans and machines. Against the background of formaliz...

Der „akute arterielle Verschluss“ beschreibt ein Zustandsbild, weniger eine Gefäßpathologie. Er ist Anlass zu einer umgehenden Diagnostik und Behandlung, denn die abhängige Körperprovinz ist durch die akute Mangeldurchblutung beim arteriellen Verschluss vital gefährdet. Diese vitale Gefährdung äußert sich in einem Zustandsbild, welches plakativ mit...

Die periphere arterielle Verschlusserkrankung führt zu Ischämieschmerz, der zur Behandlung zwingt. Auch die gefäßchirurgische Therapie selbst verursacht perioperative Schmerzen. Somit ist ein perioperatives Schmerzmanagement neben der kausalen Therapie gefragt. Schmerzen müssen gemessen und angemessen behandelt werden. Systemisch wirkende Medikamen...

Purpose: To examine the outcomes of all first-line strategies for the treatment of critical limb ischemia (CLI), identify factors that influenced the treatment choice, and determine the risk of amputation or death after each treatment. Methods: CRITISCH ( ClinicalTrials.gov identifier NCT01877252) is a multicenter, national, prospective registry...

Objective: An analysis was conducted of intermediate outcomes and possible influencing factors in patients with end-stage renal disease (ESRD) and critical limb ischemia after lower limb revascularization compared with patients with regular renal function (non-ESRD). Methods: Data collection was performed by inquiry of the German multicenter reg...

Objective: Secondary prevention in patients with critical limb ischemia (CLI) is crucial for the reduction of cardiovascular morbidity and mortality. Nonetheless, current recommendations are extrapolated from other high-risk populations because of the lack of CLI-dedicated trials. The aim of this explorative study was to evaluate the association o...

Vascular surgery is one of the fastest growing surgical specialties in German medicine. Nevertheless, strong efforts have to be made to educate and support young vascular surgeons with high potential and enable them to apply for academic posts. Therefore, the German Society of Vascular Surgeons (DGG) is going to establish an Excellence Academy to p...

Background In 2010, the German Medical Association commissioned the Federal Chamber of Physicians (FCP) to prepare an amendment to the Model Specialty Training Regulations (MSTR). In order to maintain long-term validity of the content of the specialty training, despite exponential knowledge growth and a continuously changing framework, for the firs...

Endovascular therapy has become the primary treatment option for elective abdominal aortic aneurysms. In the long-term, however, a quarter of the patients after EVAR must undergo secondary interventions in order to maintain an adequate aneurysm exclusion and ultimately to prevent negative aneurysm-associated consequences (7% secondary aneurysmal ru...

Critical limb ischemia (CLI) is growing in global prevalence and is associated with high rates of limb loss and mortality. However, a relevant gap of evidence about the most optimal treatment strategy still exists. The aim of this study of the prospective, multicenter First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) registry...

Background: Since its introduction, endovascular aortic aneurysm repair (EVAR) has proved as a favourable alternative to open surgery (OR) in the treatment of abdominal aortic aneurysms (AAA). Long-term outcomes of EVAR and OR are similar while complications are more likely to develop after EVAR. Risk factors for mortality and complications after A...

Objective The vascular surgery patient population was defined in a pilot study in terms of the stages of peripheral arterial occlusive disease (PAOD), the frequency of treatment methods and the results. Preoperative risk factors, perioperative morbidity and mortality of endovascular (ER) and open revascularization (OR) were analyzed.MethodA total o...

In diesem Beitrag wurde auf S.1 eine falsche Thrombozytenzahl angegeben. Statt 150.00/µl muss es heißen: Die Thrombozytopenie ist bei 85–90% der Patienten das erste Anzeichen einer HIT II, mit einem abrupten Abfall der Thrombozyten unter 150.000/μl oder um mehr als 50% des Basiswertes.Wir bitten, die korrekte Nennung zu beachten und den Fehler zu e...

Der akute arterielle Verschluss erfordert – nicht nur in der Intensivmedizin – die zeitnahe Diagnostik und Therapie. In 80 % der Fälle sind die Extremitätenarterien betroffen, von besonderer klinischer Relevanz sind aber wegen potenzieller Lebensbedrohung die Verschlüsse der Viszeralarterien und der Aorta. Aufgrund der Akuizität und der Gefahr des...

Background The direct thrombin inhibitor argatroban is available for parenteral antithrombotic treatment of patients with heparin-induced thrombocytopenia type II (HIT II).Method Experiences with argatroban were exchanged in a workshop based on case reports and a survey of experts. The aim was to define the indications and modalities for administra...

Hintergrund Die Ruptur eines abdominalen Aortenaneurysmas (AAA) ist mit einer hohen Letalitat assoziiert. Die rechtzeitige Diagnose und elektive Operation eines rupturgefahrdeten AAA stellt die einzig mogliche praventive Therapie dar. Mittels einer B-Bild-Sonographie konnen AAAs mit hoher Zuverlassigkeit fruhzeitig erkannt werden. Ein populationsba...

According to the review article (1), iatrogenic nerve injuries can be caused by transection, crushing and compression, penetration, and twisting by screws. Among the procedures associated with iatrogenic nerve injury, herniotomy is described as a major abdominal surgical procedure. This view certainly differs from the general perception, as inguina...

Zielsetzung Die Daten für das Jahr 2013 des Registers „Abdominelles Aortenaneurysma“ (AAA) des DIGG der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin sollen vorgestellt und die Ergebnisse mit denen anderer Register verglichen werden. Methodik Im Jahr 2013 beteiligten sich an dem Register insgesamt 76 Zentren. Für die offene Versorgu...

Die Arteriosklerose ist eine der wichtigsten Krankheits- und Todesursachen in Industrieländern. Risikofaktoren sind neben Alter und männlichem Geschlecht Rauchen, Hypertonie, erhöhte Blutfette, Diabetes, Übergewicht und Adipositas. Typische Manifestationen sind koronare Herzerkrankung (KHK), Arteriosklerose der Halsschlagader und der hirnversorgend...

In this study the activation of HMGA2 and overexpression by FGF1-driven stimulation of adipose tissue derived stem cells (ADSCs) in adipose tissue tumors were analyzed. In addition, the expression of HMGA2 and PPAR-gamma mRNA were quantified in canine subcutaneous abdominal adipose tissue from normal and overweight purebred dogs. ADSCs and adipose...

Background The arterial vascular diseases grouped under the term arteriosclerosis are characterized by fibrous changes in the blood vessel walls. Aim of the study This article reviews the epidemiology and manifestations of arteriosclerosis, as well as the risk factors associated with developing the disease. Materials and methods The current article...

FallberichtEin 61-jähriger Mann (insulinpflichtiger Diabetes mellitus, Hypercholesterinämie, ehemaliger Raucher mit 30 „pack years“ stellt sich mit einer nicht heilenden Läsion des lateralen Fußrandes in der Sprechstunde vor. Bei Mediasklerose und klinisch nicht tastbarem Popliteapuls wird eine i. a. DSA veranlasst, die einen langstreckigen Verschl...

Supplement Fig. 1 Histograms showing the distribution of 157 human abdominal subcutaneous adipose tissue samples and their relative expression of p14 Arf , p21, and BAX (a-c). One-sample Kolmogorov–Smirnov test revealed that the test distribution of p14 Arf (asymptotic significance (2-tailed) = 0.004) and p21 (asymptotic significance (2-tailed) = 0...

There is a clear link between overweight, gain of white adipose tissue, and diabetes type 2 (T2D). The molecular mechanism of the gain of adipose tissue is linked with the expression of high mobility group protein AT-hook 2 (HMGA2), and recent studies revealed an association with a SNP near HMGA2. In this study, we investigated the gene expression...

Mit der Etablierung der minimal-invasiven Gefäßchirurgie gewinnt die Leistenarterie als Zugangsgefäß immer mehr an Bedeutung. Der Zugang zum Gefäß kann durch Punktion, längsgerichtete Standardfreilegung oder in der minimal-invasiven schräggestellten Inzision durchgeführt werden. Bedingt durch die anatomischen Bezüge zu Lymphgefäßen, Nerven und Arte...

Seit 5 Jahren gibt es eine Kommission „Perioperative Medizin“ in der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG, Infobox 1). Die Kongresse der DGG in Berlin (Debus 2010), Erlangen (Lang 2011) und Wiesbaden (Schmitz-Rixen 2012) boten Schwerpunktthemen der perioperativen Medizin, die auf erfreulich positive Resonanz stießen.Infob...

Vascular tumors seldom occur, they are not classified in the TNM System. We discriminate tumors of the endothelium in benigne, intermediate or high grade malignancy. In addition, we find tumors of the perivascular tissue and non-vascular tumors with vascular infiltration. Vascular tumors should be treated by «wide excision» or compartment resection...

After the establishment of the different operation procedures, in the 1970s and 1980s, PTA and stenting were favoured in the follow-ing decade. Current operative, interventional and endovascular procedures are described and the results of several multicentre studies are discussed. Vascular surgery was required only for treatment of complications an...

Zusammenfassung Die präoperative Evaluation und das perioperative Management der koronaren Herzerkrankung bei Patienten mit vaskulären Eingriffen stellt eine große Herausforderung mit bedeutenden Auswirkungen für das operative Ergebnis dar. Myokardinfarkt und kardialer Tod sind die Hauptursachen der perioperativen Mortalität von Gefäßpatienten. Ein...

Komplikationen nach aortofemoralen Rekonstruktionen sind selten. Sie sind abhängig von einer sauberen Indikationsstellung, einer risikoadaptierten Therapie und einer subtilen Präparations- und Operationstechnik. Die vorliegende Arbeit diskutiert Komplikationen wie Verschlüsse, Blutungen, Infekte, Prothesendilatationen, Nahtaneurysmen, pelvines Isch...

HMGA2 is a major regulator of benign tumorigenesis from mesenchyme-derived tissues and stem-cell self-renewal. It has been postulated that HMGA2 mediates its critical function by decreasing p16(Ink4a)/p14(Arf) expression and cellular senescence. To repress the oncogenic activity of HMGA2, the lin-28-let-7 axis is thought to increasingly repress the...

Zusammenfassung Die Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin hat im Jahr 2009 eine Kommission für perioperative Medizin ins Leben gerufen. An einem Fallbeispiel werden die interdisziplinären Schnittstellenprobleme eines Patienten mit einem Bauchaortenaneurysma vorgestellt und Lösungen für die Probleme vorgeschlagen und dargelegt. M...

Clinical symptoms of graft occlusions can be different. In a threatened lower limb with severe pain, the indication for thrombectomy is clear. In relationship to the urgency of vascular treatment thrombectomy is planned. If there is more time for decision making in subacute occlusion, thrombolysis can be the alternative. Combination of operation an...

Für die Planung eines operativen Eingriffs ist in der Gefäßchirurgie neben der Auswahl des Operationsverfahrens und der Implantatwahl die Auswahl des Zuganges von entscheidender Wichtigkeit. Gefäße müssen für eine Sanierung – unabhängig von der Gefäßpathologie oder der Art der Erkrankung – entweder direkt am Ort freigelegt und präpariert werden, od...

Zusammenfassung Bei den Gefäßverletzungen werden arterielle und venöse Läsionen unterschieden. Abhängig vom Verletzungsmechanismus sind verschiedene Gefäßoperationen zur Versorgung erforderlich: von der direkten Naht über Reanastomosierung, Thrombektomie und Defektüberbrückung bis zur endovaskulären Chirurgie kommt das gesamte gefäßchirurgische Rep...

The intrapancreatic ampullar/duo-denal diverticula is a rare cause of a posthepatic icterus. Duodenal diverticula are scarcely symp-tomatic. They mostly occur as gastrointestinal bleeding, unspecific stomachache or painless icterus and are most frequently diagnosed by endoscopy or intraoperatively. The radiographic differentiation between duode-nal...

Acute gastrointestinal bleeding is one of the most frequent medical emergencies. The most common causes are inflammations, ulcers, neoplasms and angiodysplasias. They can usually be diag-nosed and treated via endoscopy, but less frequent causes, which require increased diagnostic and therapeutic efforts, must also be considered. We present the case...

Acute gastrointestinal bleeding is one of the most frequent medical emergencies. The most common causes are inflammations, ulcers, neoplasms and angiodysplasias. They can usually be diagnosed and treated via endoscopy, but less frequent causes, which require increased diagnostic and therapeutic efforts, must also be considered. We present the case...

The intrapancreatic ampullary duodenal diverticula is a rare cause of a posthepatic icterus. Duodenal diverticula are scarcely symptomatic. They mostly occur as gastrointestinal bleeding, unspecific stomachache or painless icterus and are most frequently diagnosed by endoscopy or intraoperatively. The radiographic differentiation between duodenal d...

Summary Patients with effusive pericardial disease are often in poor general condition and therefore a well-tolerated therapy is important. We describe a relatively safe endoscopic pericardial window procedure. In this way it is possible to combine a minimally invasive procedure with sufficient diagnosis and therapy.

Summary Endarterectomy is often performed in vascular surgery by either open surgery or by the ring stripper. If endarterectomy produces loose intimal edges, sutures are required to avoid dissection of the wall. As sutures are a risk factor for re-stenosis of the artery, laser fixation was performed as an alternative. In an ex-vivo study, intimal e...

After the different episodes of open aneurysm repair (resection, inlay technique, intraaortic prosthesis) we recognize the development of endovascular surgery since 1991. Meantime we can use divices that allow save and durable management, if the inclusing criteria are respected. Complication rates were halved in the last years, as the literatur sho...

The intrapancreatic ampullary duodenal diverticula is a rare cause of a posthepatic icterus. Duodenal diverticula are scarcely symptomatic. They mostly occur as gastrointestinal bleeding, unspecific stomachache or painless icterus and are most frequently diagnosed by endoscopy or intraoperatively. The radiographic differentiation between duodenal d...

HMGB1 is a high mobility group protein that can act either as a DNA binding protein or extracellularly as a cytokine-like danger signal. Extracellular HMGB1, either actively secreted or passively released by necrotic cells, is linked to inflammation and cancer. Herein, the results of a study to quantify the expression of HMGB1 in lymphomas by quant...

Several studies indicate that high-volume hospitals have better results in open repair of unruptured abdominal aortic aneurysms (AAA). Up to now no studies had addressed this question in German hospitals. Post-hoc-analysis from a prospective physician-led registry. Since 1999, the German Society for Vascular Surgery has conducted a prospective regi...

Outpatient surgery is accepted in vascular medicine, for the 5th Sozialgesetzbuch in germany promotes pacemaker-implantation, port-implantation, shunt-surgery and surgery for varicosis in the ambulant way. Excluding carotid surgery or intervention, in the own hospital interventional and endovascular procedures are performed in the outpatient depart...

Fr die Behandlung des zentralen Nahtaneurysmas nach aortaler Gefoperation gibt es keinen Knigsweg – mit der endovaskulren Aneurysmaausschaltung ist das Therapiespektrum allerdings wertvoll erweitert worden. Die Indikation zur Korrektur orientiert sich an den Kriterien der elektiven Aneurysmachirurgie, fr die ein klinikinterner Algorithmus A.D.A.M....

Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of...

Advances in conventional vascular surgery, endovascular procedures and conservative treatment require close interdisciplinary cooperation. The term Vascular Centre indicates to patients and referring doctors optimal professional and organisational competence. 73 applications by vascular centres for certification were made between June 2002 and Dece...

Hintergrund und Fragestellung: Die Fortschritte im Bereich der konventionellen Gefäßchirurgie, der endovaskulären Verfahren und der konservativen Therapie erfordern eine enge interdisziplinäre Kooperation. Der Terminus Gefäßzentrum signalisiert gegenüber Patienten und Zuweisern eine optimale fachliche und organisatorische Kompetenz. Zur Sicherstell...

Zusammenfassung Die Karotis-TEA stellt eine evidente Maßnahme in der Prophylaxe des karotisbedingten ischämischen Schlaganfalls dar, sofern eine niedrige perioperative Komplikationsrate erzielt wird. Zwischen 1999 und 2001 wurden im Qualitätssicherungsprojekt „Karotis-TEA“ der Deutschen Gesellschaft für Gefäßchirurgie 12.041 elektive prä- und posto...

Background Advances in vascular medicine in the areas of conventional vascular surgery, endovascular processes, and conservative therapy require, for both medical and economic reasons, close interdisciplinary cooperation. The designation vascular center signals to patients and admitting physicians optimal specialist and organisational competence. T...

Physiology of growing old is examined in clinical and molecular aspects, today there are even trials to influence »growing old«. Nevertheless, the definition of »being old« is different in the internal, geriatric and the social-medical view. Evaluation of the elderly patient means cardiological, pulmonal, gastroenterological and angiological risk m...

One of the major characteristics of atherosclerosis is the migration of smooth muscle cells (SMC) from the tunica media to the intima, caused by alterations in the environment, e.g. mechanical, chemical, or immunologic injuries of the arterial walls. A group of molecules that may act as a main regulator of SMC phenotype switching is formed by the s...

In einer prospektiven und randomisierten Multicenterstudie wurden 175 Patienten mit einem infrarenalen Bauchaortenaneurysma operiert. Dabei wurden die Gelsoft-PlusTM-Prothese der Fa. Vascutec Terumo Corp., Hamburg und die MicrovelTM -Prothese der Fa. Boston Scientific, Ratingen, Deutschland, verwendet. Postoperativ und nach 6, 12 und 24 Monaten wur...

We present the case report of a 68-year-old female patient who had a malignant gastrointestinal stromal tumor of the papilla of Vater. The abdominal CT showed a coin-shaped lesion in the liver (segment VIII). Intraoperative rapid histological examination detected an old parasitic hepatic cyst. To exclude metastasis, we performed duodenopancreatecto...

Wir berichten ber eine 68-jhrige Patientin, die uns mit einem malignen gastrointestinalen Stromatumor der Papille zur Operation vorgestellt wurde. In der weiteren Umfelddiagnostik fiel ein Rundherd im VIII. Lebersegment auf, wobei es sich schnellschnitthistologisch um eine alte parasitre Leberzyste handelte, so dass eine Duodenopankreatektomie unte...

Serous cystadenoma of the pancreas' head is a benign lesion which seldom occurs. By computed tomography, explorative laparotomia and intraoperative ultrasound diagnosis can be verified, so that duodenum preserving pancreatic head resection can be performed to avoid duodenopancreatectomy.

MRSA-management in vascular diabetic foot syndrome means diagnosis of infection, cohort isolation, decontamination and an early debridement. In ischemic vascular diabetic foot syndrome bypass surgery for restauration of sufficient perfusion of the limb is required. By definition of algorithms for treatment it is possible to reduce the increase of M...

Late complications following conventional repair of abdominal aortic surgery were measured in 304 patients. Further operations were necessary in 4.6 % of the patients after an average time of 8 years. Indications for further operation were: Suture line aneurysms (6), endoleak (2), kinking of the prosthesis (2), occlusion (2), infection (2). In one...

In einer retrospektiven Studie wurden Spätkomplikationen nach konventioneller Aortenchirurgie unter 304 Patienten erfasst. Korrekturoperationen an der Aorta waren bei 4,6 % der Patienten durchschnittlich 8 Jahre nach der Erstoperation erforderlich. Anlass für die Zweitoperation waren Nahtaneurysmen (6), perfundierter Aneurysmasack (2), Prothesenkin...

Die Proliferation glatter Muskelzellen stellt einen entscheidenden initialen Schritt bei der Entstehung arteriosklerotischer Plaques sowie postangioplastischer Restenosierun-gen dar. Frühere Untersuchungen an Uterus-Leiomyomen zeigten, daß die Expression der Mitglieder der HMGA-Genfamilie (HMGA1 und HMGA2) von entscheidender Bedeutung für die Proli...

Zusammenfassung Bei einer 36-jährigen Patientin wurde zufällig eine Raumforderung der 1. Rippe links durch Röntgenuntersuchung entdeckt. Nach präoperativer Szintigraphie, Angiographie und Computertomographie erfolgte eine transaxilläre En-bloc-Resektion mit Reimplantation der A. subclavia in den Aortenbogen. Histologisch wurde die seltene fibröse...

A tumor of the first rib was accidentally discovered by X-ray examination in a 36-year-old female patient. Following preoperative scintigram, angiogram, and computed tomography, transaxial en bloc resection of the first rib and reimplantation of the subclavian artery into the aortic arch was performed. Histological examination revealed a rare fibro...

In comparison to pancreatic cancer, extrahepatic cholangiocarcinoma has a better prognosis and a higher resection rate, but it is tainted with the occurrence of metachronic tumors. Metachronic tumors of the female genitalia are described in the literature, but metachronic gastric cancer after curative treatment of cholangiocacinoma is also possible...

In comparison to pancreatic cancer, extrahepatic cholangiocarcinoma has a better prognosis and a higher resection rate, but it is tainted with the occurrence of metachronic tumors. Metachronic tumors of the female genitalia are described in the literature, but metachronic gastric cancer after curative treatment of cholangiocacinoma is also possible...

Die lokoregionale Lyse ist ein wirkungsvolles Verfahren zur Bandlung von Verschlüssen der arteriellen und venösen Strombahn. Dies ist bereits aus pharmakologischer Sicht verständlich, denn die Fibrinolyse ist ein physiologischer Prozeß, der im Körper permanent abläuft; die Lyse-Therapie imitiert somit lediglich physiologische Vorgänge. So finden si...

Bei Patienten, die sich nach aorto(bi)femoralem Gefäßersatz erneut in gefäßchirurgische Behandlung begeben, finden sich neben Veränderungen am Gefäßprothesenmaterial selbst auch fortschreitende Erkrankungen der abhängigen Strombahn. Unter 200 aortobifemoralen Gefäßrekonstruktionen wurden bei 54 Patienten Zweitangiographien durchgeführt, die eine Ve...

In patients who return to vascular surgery after aortobifemoral bypass procedures, degeneration of the graft material and progress in disease of the femorodistal arteries can be observed. After 200 aortobifemoral bypass procedures, a follow-up angiography was performed in 54 patients. Measurement of the distal vessel to diameter was possible using...

Emergency treatment of bleeding ulcer of the duodenum is endoscopy and endoscopic blood-staunching. In high-risk patients with Forrest Ia lesions or ulcers with visible vessel (Forrest IIa) endoscopic follow-up or early elective operation is required. Fibrin sealing can improve the results of endoscopic injection therapy for bleeding ulcer. Neverth...

Die Notfallbehandlung des blutenden Ulcus duodeni besteht in der Endoskopie und der endoskopischen Blutstillung. Bei Hochrisikopatienten mit Forrest-I a-Läsionen oder Ulcera mit Gefäßstumpf (Forrest II a) sollte eine endoskopische Folgetherapie oder die frühelektive Operation geplant werden. Fibrinklebung kann die Ergebnisse endoskopischer Injektio...

Since 1996 a simple classification of surgical interventions has been used to guarantee adequate intraoperative anesthesiological volume management. Use of this classification, including extension of operation and operative trauma, resulted in 45% less substitution with blood components in comparison to that observed in 1995.

Since 1996 a simple classification of surgical interventions has been used to guarantee adequate intraoperative anesthesiological volume management. Use of this classification, including extension of operation and operative trauma, resulted in 45% less substitution with blood components in comparison to that observed in 1995.

Zusammenfassung Strahleninduzierte Gefäßverschlüsse sind selten. Prädisponiert ist die iliakofemorale Strombahn nach radiologischer Behandlung von Unterbauchtumoren. Die Problematik der Gefäßrekonstruktion wird anhand einer Kasuistik einer 78jährigen Patientin verdeutlicht, bei der nach strahleninduziertem Verschluß der linken Beckenstrombahn zunäc...