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Perkutane Zugänge zur endovaskulären PAVK-Therapie

Femoral, popliteal, pedal

Percutaneous access for endovascular therapy of PAOD

Femoral, popliteal and pedal

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Zusammenfassung

Hintergrund

Die perkutane Intervention bei Patienten mit peripherer arterieller Verschlusskrankheit (PAVK) erfolgt in der Regel über einen transfemoralen arteriellen Gefäßzugang retro- oder antegrad. Zuweilen sind chronische femoropopliteale und krurale Gefäßverschlüsse auf diesem Wege mit den verfügbaren Standardmethoden nicht rekanalisierbar.

Ziel der Arbeit

Beschreibung und Wertung transfemoraler, -poplitealer und -pedaler Gefäßzugänge zur Behandlung der fortgeschrittenen peripheren arteriellen Verschlusskrankheit.

Material und Methoden

Literaturrecherche verfügbarer Studien zu endovaskulären Interventionen über ergänzende distale Zugänge.

Ergebnisse

Durch moderne subintimale Verfahren und/oder ergänzende retrograde Ansätze sind heute auch komplexe Arterienverschlüsse endovaskulär rekanalisierbar. Die Erfolgsrate ist auch abhängig von der Expertise mit den entsprechenden Verfahren und den verwendeten Materialien.

Diskussion

Der transfemorale Zugang bleibt die erste Wahl zur Behandlung von Patienten mit PAVK. Zusätzliche retrograde Ansätze über einen distalen Zugang bilden eine Alternative nach fehlgeschlagenem antegradem Interventionsversuch.

Abstract

Background

Percutaneous interventions in patients with peripheral arterial occlusive disease (PAOD) are usually performed from an antegrade or retrograde transfemoral arterial access; however, sometimes chronic femoropopliteal and crural occlusions cannot be negotiated via this route with traditional standard methods.

Objectives

Description and evaluation of transfemoral, transpopliteal and transpedal vascular approaches for the treatment of advanced PAOD.

Material and methods

A literature review of available studies on endovascular interventions with distal retrograde access was carried out.

Results

Most complex arterial occlusions can be treated by employing modern subintimal procedures and/or additional retrograde approaches. The success rate also depends on the expertise with the appropriate technique and materials used.

Conclusion

The transfemoral access remains the first choice for the treatment of patients with PAOD. Additional retrograde approaches from a more distal access constitute an alternative after failure of antegrade intervention attempts.

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Abbreviations

AF:

A. fibularis

AP:

A. poplitea

AFC:

A. femoralis communis

AFP:

A. femoralis profunda

AFS:

A. femoralis superior

AP:

A. poplitea

ATA:

A. tibialis anterior

ATP:

A. tibialis posterior

BTK:

„Below the knee“

DL:

Durchleuchtung

DP:

Dorsalis pedis

PAVK:

Periphere arterielle Verschlusskrankheit

US:

Ultraschall

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Authors and Affiliations

  1. Zentrum für Radiologie, HELIOS Klinikum Wuppertal, Klinikum der Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    L. Kamper & P. Haage

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Correspondence to L. Kamper.

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L. Kamper und P. Haage geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Kamper, L., Haage, P. Perkutane Zugänge zur endovaskulären PAVK-Therapie. Radiologe 56, 223–232 (2016). https://doi.org/10.1007/s00117-015-0075-5

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