Endovaskuläre vs. konventionelle Gefäßchirurgie – antiquiertes Denken?

Teil 2: Karotisstenose und periphere arterielle Verschlusskrankheit

Endovascular versus conventional vascular surgery – old-fashioned thinking?

Part 2: carotid artery stenosis and peripheral arterial occlusive disease

Zusammenfassung

Die endovaskuläre Gefäßchirurgie hat die konventionelle operative Gefäßchirurgie in weiten Bereichen verdrängt. Dies hat dazu geführt, dass beide Techniken vielerorts als miteinander konkurrierende Verfahren angesehen werden. Evidenzbasierte Daten aus randomisierten Studien, Metaanalysen und klinischen Registern belegen jedoch zunehmend deutlich, dass sich die beiden Technologien komplementär ergänzen. Dabei ist es von der jeweiligen Grunderkrankung und der Anatomie abhängig, welcher der beiden Vorgehensweisen der Vorzug zu geben ist – wobei auch die kombinierte Nutzung beider Verfahren (Hybridtechnik) sinnvoll sein kann. Die vorliegende Übersicht konzentriert sich auf die Versorgung von Patienten mit Karotisstenose, mit intermittierender Klaudikation sowie mit kritischer und akuter Extremitätenischämie.

Abstract

Endovascular therapy has widely replaced conventional open vascular surgical reconstruction. For this reason, both techniques were widely considered to be competing approaches. Evidence-based data from randomized prospective trials, meta-analyses and clinical registries, however, demonstrated that both techniques should be used to complement each other. It became increasingly more evident that the use of either procedure depends on the underlying disease and the anatomical conditions, whereby a combination of both (hybrid approach) may be the preferred option in certain situations. This review focuses on the treatment of patients with carotid artery stenosis, intermittent claudication, critical limb ischemia and acute limb ischemia.

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Correspondence to Prof. Dr. E. S. Debus.

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E.S. Debus, T. Kölbel, D. Manzoni, C.-A. Behrendt, F. Heidemann und R.T. Grundmann geben an, dass kein Interessenkonflikt besteht.

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Den Beitrag „Endovaskuläre versus konventionelle Gefäßchirurgie – antiquiertes Denken? Teil 1: Eingriffe an der Aorta“ finden Sie in Ausgabe 3/2016 von Der Chirurg oder unter DOI:10.1007/s00104-015-0146-1

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Debus, E.S., Manzoni, D., Behrendt, CA. et al. Endovaskuläre vs. konventionelle Gefäßchirurgie – antiquiertes Denken?. Chirurg 87, 308–315 (2016). https://doi.org/10.1007/s00104-015-0149-y

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Schlüsselwörter

  • Karotisstenose
  • Intermittierende Klaudikation
  • Kritische Extremitätenischämie
  • Akute Extremitätenischämie
  • Endovaskulär

Keywords

  • Carotid artery stenosis
  • Intermittent claudication
  • Critical limb ischemia
  • Acute limb ischemia
  • Endovascular