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.
Literatur
Bonati LH, Lyrer P, Ederle J et al (2012) Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev 9:CD000515
Touzé E, Trinquart L, Felgueiras R, Carotid Stenting Trialists’ Collaboration et al (2013) A clinical rule (sex, contralateral occlusion, age, and restenosis) to select patients for stenting versus carotid endarterectomy: systematic review of observational studies with validation in randomized trials. Stroke 44:3394–3400
Mas JL, Chatellier G, Beyssen B, EVA-3S Investigators et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355:1660–1671
Mas JL, Arquizan C, Calvet D, EVA-3S Investigators et al (2014) Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke 45:2750–2756
Ederle J, Dobson J, Featherstone RL, International Carotid Stenting Study investigators et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375(9719):985–997
Bonati LH, Dobson J, Featherstone RL et al (2015) Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 385(9967):529–538
Brott TG, Hobson RW 2nd, Howard G, CREST Investigators et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23
Vilain KR, Magnuson EA, Li H, CREST Investigators et al (2012) Costs and cost-effectiveness of carotid stenting versus endarterectomy for patients at standard surgical risk: results from the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 43:2408–2416
Paraskevas KI, Kalmykov EL, Naylor AR (2015) Stroke/death rates following carotid artery stenting and carotid endarterectomy in contemporary administrative dataset registries: a systematic review. Eur J Vasc Endovasc Surg. doi:10.1016/j.ejvs.2015.07.032
Malgor RD, Alahdab F, Elraiyah TA et al (2015) A systematic review of treatment of intermittent claudication in the lower extremities. J Vasc Sur 61(3 Suppl):54S–73S
Lindgren H, Gottsäter A, Qvarfordt P et al (2014) Invasive treatment for infrainguinal claudication has satisfactory 1 year outcome in three out of four patients: a population-based analysis from Swedvasc. Eur J Vasc Endovasc Surg 47:615–620
Scali ST, Rzucidlo EM, Bjerke AA et al (2011) Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease. J Vasc Surg 54:714–721
Aihara H, Soga Y, Mii S, RECANALISE Registry Investigators et al (2014) Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-II C and D femoropopliteal disease. Circ J 78:457–464
Siracuse JJ, Giles KA, Pomposelli FB et al (2012) Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg 55:1001–1007
Sachs T, Pomposelli F, Hamdan A et al (2011) Trends in the national outcomes and costs for claudication and limb threatening ischemia: angioplasty vs. bypass graft. J Vasc Surg 54:1021–1031
Debus ES, Grundmann RT (2015) Evidenzbasierte Gefäßchirurgie. Springer, Berlin. (Kapitel 9)
Jones WS, Dolor RJ, Hasselblad V et al (2014) Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia. Am Heart J 167:489–498
Abu Dabrh AM, Steffen MW, Asi N et al (2015) Bypass surgery versus endovascular interventions in severe or critical limb ischemia. J Vasc Surg 62:1330–1339
Soga Y, Mii S, Iida O et al (2014) Propensity score analysis of clinical outcome after bypass surgery vs. endovascular therapy for infrainguinal artery disease in patients with critical limb ischemia. J Endovasc Ther 21:243–253
Arvela E, Venermo M, Söderström M et al (2011) Infrainguinal percutaneous transluminal angioplasty or bypass surgery in patients aged 80 years and older with critical leg ischaemia. Br J Surg 98:518–526
Dosluoglu HH, Lall P, Harris LM, Dryjski ML (2012) Long-term limb salvage and survival after endovascular and open revascularization for critical limb ischemia after adoption of endovascular-first approach by vascular surgeons. J Vasc Surg 56:361–371
Garg K, Kaszubski PA, Moridzadeh R et al (2014) Endovascular-first approach is not associated with worse amputation-free survival in appropriately selected patients with critical limb ischemia. J Vasc Surg 59:392–399
Bisdas T, Borowski M, Torsello G, First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) Collaborators (2015) Current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg 62:965–973
Debus ES, Grundmann RT (2015) Evidenzbasierte Gefäßchirurgie. Springer, Berlin. (Kapitel 10)
Wang JC, Kim AH, Kashyap VS (2015) Open surgical or endovascular revascularization for acute limb ischemia. J Vasc Surg. doi:10.1016/j.jvs.2015.09.055
Taha AG, Byrne RM, Avgerinos ED et al (2015) Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. J Vasc Surg 61:147–154
Byrne RM, Taha AG, Avgerinos E et al (2014) Contemporary outcomes of endovascular interventions for acute limb ischemia. J Vasc Surg 59:988–995
Argyriou C, Georgakarakos E, Georgiadis GS et al (2014) Hybrid revascularization procedures in acute limb ischemia. Ann Vasc Surg 28:1456–1462
de Donato G, Setacci F, Sirignano P et al (2014) The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg 59:729–736
Genovese EA, Chaer RA, Taha AG et al (2015) Risk factors for long-term mortality and amputation after open and endovascular treatment of acute limb ischemia. Ann Vasc Surg. doi:10.1016/j.avsg.2015.10.004
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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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DOI: https://doi.org/10.1007/s00104-015-0149-y
Schlüsselwörter
- Karotisstenose
- Intermittierende Klaudikation
- Kritische Extremitätenischämie
- Akute Extremitätenischämie
- Endovaskulär