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Management peripherer Gefäßerkrankungen gemäß aktueller Leitlinien

Periphere arterielle Verschlusskrankheit vom Becken-Bein-Typ und extrakranielle Karotisstenose

Management of peripheral vascular disease based on current guidelines

Peripheral artery occlusive disease of the iliac and femoral arteries and carotid artery stenosis

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Zusammenfassung

Diese Übersicht fasst die aktuellen europäischen und amerikanischen Leitlinien zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK) vom Becken-Bein-Typ und der extrakraniellen Karotisstenose zusammen. Im Vergleich zu älteren Leitlinien ergeben sich insbesondere zur interventionellen Behandlung der pAVK, die mit Ausnahme sehr langstreckiger, komplexer Gefäßläsionen der Becken- und Beingefäße nunmehr als Revaskularisationsverfahren der 1. Wahl angesehen wird, und zur medikamentösen Begleittherapie beider Gefäßerkrankungen neue Aspekte. Neben einer Thrombozytenfunktionshemmung (TFH) zur Reduktion des Risikos für Herzinfarkt und Schlaganfall ist im Rahmen der Therapie der kardiovaskulären Risikofaktoren auch bei Patienten mit Karotisstenose und pAVK insbesondere die Gabe von Statinen neu in den Fokus gerückt. Diese Gefäßpatienten sollten diesbezüglich wie Patienten mit koronarer Herzkrankheit behandelt werden.

Abstract

The article summarizes the recommendations of current European and American guidelines concerning the diagnosis and treatment of peripheral arterial occlusive disease and carotid artery stenosis. In comparison to older recommendations, current guidelines concerning endovascular treatment and concomitant medical therapy have been changed in recent years. With the exception of very complex and long lesions, endovascular methods are seen as the therapy of choice for revascularization of the iliac and femoral arteries. For cardiovascular risk reduction, patients with symptomatic peripheral arterial disease and stenosis of the carotid arteries should receive antiplatelet as well as statin therapy and should not be treated different from patients with coronary artery disease.

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Literatur

  1. Tendera M, Aboyans V, Bartelink ML et al (2011) ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32(22):2851–2906

    Article  PubMed  Google Scholar 

  2. Smith SC Jr, Benjamin EJ, Bonow RO et al (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 124(22):2458–2473

    Article  PubMed  Google Scholar 

  3. Rooke TW, Hirsch AT, Misra S et al (2011) 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 58(19):2020–2045

    Article  PubMed  Google Scholar 

  4. Hirsch AT, Haskal ZJ, Hertzer NR et al (2006) ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113(11):e463–e654

    Article  PubMed  Google Scholar 

  5. Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 33(Suppl 1):S1–S75

    Article  PubMed  Google Scholar 

  6. Alonso-Coello P, Bellmunt S, McGorrian C et al (2012) Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(Suppl 2):e669S–e690S

    PubMed  CAS  PubMed Central  Google Scholar 

  7. Fowkes FGR, Rudan D, Rudan I et al (2013) Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet [Epub ahead of print]

  8. Weerd M de, Greving JP, Hedblad B et al (2010) Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 41(6):1294–1297

    Article  PubMed  Google Scholar 

  9. Grau AJ, Weimar C, Buggle F et al (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32(11):2559–2566

    Article  PubMed  CAS  Google Scholar 

  10. Aboyans V, Criqui MH, Abraham P et al (2012) Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 126(24):2890–2909

    Article  PubMed  Google Scholar 

  11. Lijmer JG, Hunink MG Dungen JJ van den et al (1996) ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol 22(4):391–398

    Article  PubMed  CAS  Google Scholar 

  12. Aboyans V, Ho E, Denenberg JO et al (2008) The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects. J Vasc Surg 48(5):1197–1203

    Article  PubMed  Google Scholar 

  13. Anderson JL, Halperin JL, Albert NM et al (2013) Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127(13):1425–1443

    Article  PubMed  Google Scholar 

  14. Lin JS, Olson CM, Johnson ES, Whitlock EP (2013) The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 159(5):333–341

    Article  PubMed  Google Scholar 

  15. Regensteiner JG, Gardner A, Hiatt WR (1997) Exercise testing and exercise rehabilitation for patients with peripheral arterial disease: status in 1997. Vasc Med 2(2):147–155

    PubMed  CAS  Google Scholar 

  16. Dormandy JA, Rutherford RB (2000) Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 31(1 Pt 2):S1–S296

    Article  PubMed  CAS  Google Scholar 

  17. o A (1991) Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke 22(6):816–817

    Article  Google Scholar 

  18. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273(18):1421–1428

    Article  Google Scholar 

  19. European Carotid Surgery Trialists’ Collaborative Group (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351(9113):1379–1387

    Article  Google Scholar 

  20. Schneider PA, Naylor AR (2010) Transatlantic debate. Asymptomatic carotid artery stenosis – medical therapy alone versus medical therapy plus carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg 40(2):274–281

    Article  PubMed  CAS  Google Scholar 

  21. Nicolaides AN, Kakkos SK, Griffin M et al (2005) Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg 30(3):275–284

    Article  PubMed  CAS  Google Scholar 

  22. Rothwell PM, Eliasziw M, Gutnikov SA et al (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361(9352):107–116

    Article  PubMed  CAS  Google Scholar 

  23. Fowler B, Jamrozik K, Norman P, Allen Y (2002) Prevalence of peripheral arterial disease: persistence of excess risk in former smokers. Aust N Z J Public Health 26(3):219–224

    Article  PubMed  Google Scholar 

  24. Smith FB, Lowe GD, Lee AJ et al (1998) Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication. J Vasc Surg 28(1):129–135

    Article  PubMed  CAS  Google Scholar 

  25. Smith SC Jr, Benjamin EJ, Bonow RO et al (2011) AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 58(23):2432–2446

    Article  PubMed  Google Scholar 

  26. Hobbs SD, Bradbury AW (2003) Smoking cessation strategies in patients with peripheral arterial disease: an evidence-based approach. Eur J Vasc Endovasc Surg 26(4):341–347

    Article  PubMed  CAS  Google Scholar 

  27. Momsen AH, Jensen MB, Norager CB et al (2009) Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg 38(4):463–474

    Article  PubMed  CAS  Google Scholar 

  28. Amarenco P, Labreuche J (2009) Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol 8(5):453–463

    Article  PubMed  CAS  Google Scholar 

  29. Amarenco P, Bogousslavsky J, Callahan A 3rd et al (2006) High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 355(6):549–559

    Article  PubMed  CAS  Google Scholar 

  30. Sillesen H, Amarenco P, Hennerici MG et al (2008) Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke 39(12):3297–3302

    Article  PubMed  CAS  Google Scholar 

  31. Makris GC, Lavida A, Nicolaides AN, Geroulakos G (2010) The effect of statins on carotid plaque morphology: a LDL-associated action or one more pleiotropic effect of statins? Atherosclerosis 213(1):8–20

    Article  PubMed  CAS  Google Scholar 

  32. Aronow WS, Ahn C (2001) Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and symptomatic peripheral arterial disease. Am J Cardiol 87(11):1284–1286

    Article  PubMed  CAS  Google Scholar 

  33. Watson L, Ellis B, Leng GC (2008) Exercise for intermittent claudication. Cochrane Database Syst Rev 4:CD000990

    PubMed  Google Scholar 

  34. Gardner AW, Poehlman ET (1995) Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA 274(12):975–980

    Article  PubMed  CAS  Google Scholar 

  35. Bendermacher BL, Willigendael EM, Teijink JA, Prins MH (2006) Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev 2:CD005263

    PubMed  Google Scholar 

  36. Stevens JW, Simpson E, Harnan S et al (2012) Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg 99(12):1630–1638

    Article  PubMed  CAS  Google Scholar 

  37. Backer TL de, Vander Stichele R, Lehert P, Van Bortel L (2012) Naftidrofuryl for intermittent claudication. Cochrane Database Syst Rev 12:CD001368

    PubMed  Google Scholar 

  38. Ahimastos AA, Walker PJ, Askew C et al (2013) Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial. JAMA 309(5):453–460

    Article  PubMed  CAS  Google Scholar 

  39. CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348(9038):1329–1339

    Article  Google Scholar 

  40. Antithrombotic Trialists‘ (ATT) Collaboration, Baigent C, Blackwell L et al (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373(9678):1849–1860

    Article  Google Scholar 

  41. o A (2000) Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (The Dutch Bypass Oral Anticoagulants or Aspirin Study): a randomised trial. Lancet 355(9201):346–351

    Article  Google Scholar 

  42. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31(19):2369–2429

    Article  Google Scholar 

  43. Twine CP, McLain AD (2010) Graft type for femoro-popliteal bypass surgery. Cochrane Database Syst Rev 5:CD001487

    PubMed  Google Scholar 

  44. Diehm N, Schillinger M, Minar E et al (2008) TASC II section E3 on the treatment of acute limb ischemia: commentary from European interventionists. J Endovasc Ther 15(1):126–128

    Article  PubMed  Google Scholar 

  45. Halliday A et al (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363(9420):1491–1502

    Article  PubMed  CAS  Google Scholar 

  46. o A (1991) North American symptomatic carotid endarterectomy trial. Methods, patient characteristics, and progress. Stroke 22(6):711–720

    Article  Google Scholar 

  47. Fleischmann KE et al (2009) 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation 120(21):2123–2151

    Article  PubMed  Google Scholar 

  48. Halliday A, Mansfield A, Marro J et al (2010) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376(9746):1074–1084

    Article  PubMed  PubMed Central  Google Scholar 

  49. Abbott AL (2009) Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke 40(10):e573–e583

    Article  PubMed  Google Scholar 

  50. Spence JD, Coates V, Li H et al (2010) Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Arch Neurol 67(2):180–186

    Article  PubMed  Google Scholar 

  51. Brott T, Toole JF (1995) Medical compared with surgical treatment of asymptomatic carotid artery stenosis. Ann Intern Med 123(9):720–722

    Article  PubMed  CAS  Google Scholar 

  52. Chambers BR, Donnan GA (2005) Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev 4:CD001923

    PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M.T. Grebe und R. Sternitzky geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Gemeinschaftspraxis im Erlenringcenter, Herz- und Gefäßzentrum Marburg, Erlenring 19, 35037, Marburg, Deutschland

    M.T. Grebe

  2. Praxisklinik Herz und Gefäße Dresden, Dresden, Deutschland

    R. Sternitzky

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Correspondence to M.T. Grebe.

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Grebe, M., Sternitzky, R. Management peripherer Gefäßerkrankungen gemäß aktueller Leitlinien. Herz 38, 848–854 (2013). https://doi.org/10.1007/s00059-013-3985-x

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