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Periphere arterielle Verschlusskrankheit und akute Extremitätenischämie

Peripheral arterial obstruction and acute lower limb ischemia

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Zusammenfassung

In diesem Beitrag werden aktuelle evidenzbasierte Behandlungsempfehlungen für die akute und chronische Ischämie der unteren Extremitäten vor dem Hintergrund der Möglichkeiten endovaskulärer Techniken und offen-gefäßchirurgischer Strategien präsentiert. Neben der Darstellung des Spannungsbogens zwischen den differenten therapeutischen Möglichkeiten werden auch die Vorteile der Kombination beider Techniken (endovaskuläre Kombinations- oder „Hybridtherapie“) beschrieben.

Sowohl für die akute Ischämie als auch für die periphere arterielle Verschlusskrankheit werden die unterschiedlichen Therapieprinzipien entlang der verschiedenen Gefäßsegmente diskutiert. Allgemein kann konstatiert werden, dass die aortoiliakale Revaskularisation bei chronischen Obstruktionen vermehrt durch endovaskuläre Techniken oder Hybridverfahren von einem minimal-invasiven Zugang über die Femoralisgabel therapiert werden, während die akute Okklusion in diesem Segment weiterhin mittels offener Techniken (Ballonthrombektomie nach Fogarty) behandelt werden. Im infrainguinalen Segment sind bei chronischer Ischämie die endovaskulären Therapieprinzipien auf dem Vormarsch, wobei Mehretagenverschlüsse, langstreckige Okklusionen im femoralen und poplitealen Segment unverändert durch Bypasstechniken behandelt werden. Die akute Ischämie im infrainguinalen Segment wird zunehmend initial mittels endovaskulärer Methoden (Lyse und perkutane Thrombektomie) therapiert.

Abstract

In this article, current evidence-based treatment recommendations for acute and chronic lower limb ischemia will be presented considering the varied possibilities of endovascular techniques and open surgical vascular strategies. Beside presentation of the different therapeutic possibilities, advantages of the combination of both techniques will be described. Despite the BASIL trial, there are no prospective randomised controlled trials comparing endovascular and open surgical interventions. Different therapeutic rules along the different vascular segments will be discussed for both acute and chronic peripheral arterial disease. Generally it can be stated that aortoiliac revascularization for chronic obstructions is increasingly being carried out by endovascular means or hybrid procedures using a minimally invasive femoral approach, whereas acute occlusions in this vascular segment are still treated with open surgical techniques (Fogarty balloon thrombectomy). In the infrainguinal region, endovascular therapeutic strategies are gaining favor. However, multilevel occlusions and long-segment obstructions in the femoral and popliteal segment are still treated by bypass procedures. Acute ischemia in the infrainguinal segment is increasingly treated with endovascular methods (local thrombolysis and percutaneous thrombectomy).

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Städtisches Klinikum Karlsruhe gGmbH, Moltkestraße 90, 76133, Karlsruhe, Deutschland

    M. Storck

  2. Zentrum für Gefäßmedizin, Institut für Radiologie und interventionellle Therapie, Vivantes Klinikum im Friedrichshain Berlin, Berlin, Deutschland

    H.-J. Wagner

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Correspondence to M. Storck.

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Storck, M., Wagner, HJ. Periphere arterielle Verschlusskrankheit und akute Extremitätenischämie. Chirurg 78, 611–619 (2007). https://doi.org/10.1007/s00104-007-1369-6

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  • DOI: https://doi.org/10.1007/s00104-007-1369-6

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