Summary
The reconstruction of the aorto-iliac inflow tract (bypass and/or thrombendarterectomy) has become important: in concomitant peripheral arterial lesions a partial central repair with profundaplasty and lumbar sympathectomy is usually sufficient. Patients with isolated femoro-popliteal blocks (stage II) are primary candidates for conservative treatment. Long grafts beyond the knee are only justified in stages III and IV (autologues venous graft or combined grafts: centrally arterial prothesis, distally autologues vein). A good primary below knee amputation often presents a better solution than a long bypass with questionable outcome.
Zusammenfassung
Die Rekonstruktion der aorto-iliacalen Einstrombahn (Bypass und/oder Thrombendarteriektomie) kommt vorrangige Bedeutung zu. Bei zusätzlichen peripheren Verschlüssen genügt im allgemeinen eine Ein-Etagen-Korrektur (Triadenoperation). Bei isolierten femoro-poplitealen Verschlüssen im Stadium II keine Operation (Domäne konservativer Therapie!). Lange kniegelenküberschreitende Rekonstruktionen nur im Stadium III und IV gerechtfertigt (autologes Venentransplantat bzw. kombinierte Transplantate: zentral Kunststoff, peripher autologe Vene). Ein guter primärer Unterschenkelstumpf stellt oft eine bessere Lösung dar als ein nur kurzfristig funktionierender Bypass.
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Vollmar, J.F. 35. Bewährtes und Problematisches der Strombahnwiederherstellung (operative Taktik und Technik). Langenbecks Arch Chiv 352, 163–167 (1980). https://doi.org/10.1007/BF01291996
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DOI: https://doi.org/10.1007/BF01291996