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Arterielle Verschlusskrankheit

Sekundärprävention, medikamentöse Therapie, Revaskularisierung

Peripheral arterial disease

Secondary prevention, medical therapy, revascularization

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Zusammenfassung

Patienten mit einer peripheren arteriellen Verschlusskrankheit (PAVK) sind Hochrisikopatienten mit verkürzter Lebenserwartung und hohem Risiko für einen Myokardinfarkt oder Schlaganfall. Daher sollten schon früh Thrombozytenfunktionshemmer, Antidiabetika, Antihypertensiva und Lipidsenker zum Einsatz kommen. Zu berücksichtigen ist insbesondere die Nikotinentwöhnung. Sollte im Stadium II ein Gehtraining möglich sein, ist dies strukturiert unter Supervision für mindestens 6 Monate anzustreben. Weitere Therapiemaßnahmen bei deutlich eingeschränkter Gehstrecke und Lebensqualität sind der Einsatz von Vasoaktiva zur Verbesserung der Gehleistung und zusätzlich eine endovaskuläre Therapie mit Ballonangioplastie und evtl. zusätzlicher Stenteinlage bei aortoiliakalen und femoropoplitealen Läsionen. Bei PAVK III und IV, d. h. bei Patienten mit kritischer Extremitätenischämie, sind alle Optionen der Revaskularisierung auszuschöpfen, da es um den Extremitätenerhalt geht. Als Medikamente kommen lediglich Prostanoide in Betracht.

Abstract

Patients with peripheral arterial disease have a high risk of cardiovascular morbidity and mortality. Thus, antiplatelet drugs, antidiabetic, antihypertensive and antilipemic agents should be administered early on. Smoking cessation has to be encouraged and supported. In case of significant reduction of walking distance with impaired quality of life structured and supervised exercise training as well as vasoactive substances have to be offered. If technically feasible and critically discussed with the patient revascularization procedures of the aorto-iliac and the femoro-popliteal segment may be performed. In patients with critical limb ischemia, all options for vascularisation have to be utilized as the main goal is limb salvage. As medication, only prostanoids have to be considered.

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  1. Gefäßzentrum Berlin/Medizinische Klinik, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Akademisches Lehrkrankenhaus der Charité, 10365, Berlin, Deutschland

    K.-L. Schulte

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Schulte, KL. Arterielle Verschlusskrankheit. Internist 50, 927–935 (2009). https://doi.org/10.1007/s00108-009-2365-3

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