Skip to main content

Advertisement

SpringerLink
Log in

Periphere Bypasschirurgie der unteren Extremität

Peripheral bypass surgery of the lower extremity

  • Operative Techniken
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Durch die sich weiterentwickelden endovaskulären Techniken muss die Rolle der konventionellen Bypasschirurgie neu definiert werden. Sie bleibt die Methode der Wahl für Patienten mit schwerer Claudicatio oder kritischer Ischämie mit Ruheschmerz und/oder Gewebsverlust. Während kurze Gefäßstenosen oder Gefäßokklusionen endovaskulär behandelt werden, ist die konventionelle mittels Bypass bei längeren Verschlussprozessen indiziert. Einstrom und Ausstrom aus dem Bypass gewährleisten eine längerfristige Offenheit der Bypass-Systeme. Die autologe Vene ist das überragende Gefäßersatzmaterial. Dieses Review beschreibt den chirurgischen Ansatz bei Indikationsstellung, Patientenselektion, Operationstechnik wie auch die postoperative Behandlung.

Abstract

The role of peripheral bypass surgery requires redefinition as endovascular techniques evolve. Peripheral bypass surgery remains the treatment of choice for patients with severe claudication or critical ischemia, manifesting as rest pain or tissue loss. Short vascular lesions and/or occlusions can, for the most part, be corrected with endovascular techniques. Longer lesions remain the domain of conventional revascularization, providing there is sufficient influx and run-off to ensure bypass patency. Generally, autologous bypass material is preferable to alloplastic bypass material. This review describes the surgical approach with respect to indication and patient selection, patient preparation, operation technique, and postoperative care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Adam DJ, Beard JD, Cleveland T et al (2005) Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 366:1925–1934

    Article  PubMed  CAS  Google Scholar 

  2. Albers M, Romiti M, Pereira CA et al (2004) Meta-analysis of allograft bypass grafting to infrapopliteal arteries. Eur J Vasc Endovasc Surg 28:462–472

    Article  PubMed  CAS  Google Scholar 

  3. Algra A, Tangelder MJ, Lawson JA et al (2000) Interpretation of Dutch BOA trial. Dutch Bypass Oral anticoagulants or Aspirin study group. Lancet 355:1186–1187

    Article  PubMed  CAS  Google Scholar 

  4. Barker Wfc (1992) The Arteries. Landes, Austin

  5. Bergqvist D, Burmark US, Frisell J et al (1986) Prospective double-blind comparison between Fragmin and conventional low-dose heparin: thromboprophylactic effect and bleeding complications. Haemostasis 16 (Suppl 2):11–18

    PubMed  Google Scholar 

  6. Bernheim BM (1916) The ideal operation for aneurisms of the extremity. Bull Johns Hopkins Hosp 27:93–97

    Google Scholar 

  7. Biccard BM, Sear JW, Foex P (2005) Statin therapy: a potentially useful peri-operative intervention in patients with cardiovascular disease. Anaesthesia 60:1106–1114

    Article  PubMed  CAS  Google Scholar 

  8. Bradbury AW, Adam DJ, Bell J et al (2010) Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 51:5S–17S

    Article  PubMed  Google Scholar 

  9. Bruyninckx CM (1988) The use of arm veins as peripheral vascular grafts. Neth J Surg 40:41–45

    PubMed  CAS  Google Scholar 

  10. De Bakey ME, Cooley DA, Crawford ES et al (1958) Clinical application of a new flexible knitted dacron arterial substitute. Am Surg 24:862–869

    Google Scholar 

  11. Deutsche Gesellschaft für Gefäßchirurgie (2008) Leitlinie Medikamentöse Therapie.

  12. Devine C, Mccollum C (2004) Heparin-bonded Dacron or polytetrafluorethylene for femoropopliteal bypass: five-year results of a prospective randomized multicenter clinical trial. J Vasc Surg 40:924–931

    Article  PubMed  Google Scholar 

  13. Edwards ES, Edwards PD (1974) Alexis Carrel, Visionary Surgeon. Thomas, Springfield

  14. Flu HC, Lardenoye JH, Veen EJ et al (2009) Morbidity and mortality caused by cardiac adverse events after revascularization for critical limb ischemia. Ann Vasc Surg 23:583–597

    Article  PubMed  CAS  Google Scholar 

  15. Forbes JF, Adam DJ, Bell J et al (2010) Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis. J Vasc Surg 51:43S–51S

    Article  PubMed  Google Scholar 

  16. Fowkes F, Leng GC (2008) Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst Rev:CD002000

    Google Scholar 

  17. Friedmann SG (1989) A history of vascular surgery. Futura, Mount Kisco, NY

  18. Geiger G, Hoevels J, Storz L et al (1984) Vascular grafts in below-knee femoro-popliteal bypass. A comparative study. J Cardiovasc Surg (Torino) 25:523–529

    Google Scholar 

  19. Goyal A, Shah PM, Babu SC et al (2002) Popliteal-crural bypass through the posterior approach with lesser saphenous vein for limb salvage. J Vasc Surg 36:708–712

    PubMed  Google Scholar 

  20. Goyanes J (1906) Nuevos trabajos de cirugia vascular, substitucion plastica de las arterias por la vena 0 arterioplastia venosa aplicada como nuevo metodo del tratamiento de los aneurismas. El Siglo Medico 53:546–561

    Google Scholar 

  21. Hall KV (1962) The great saphenous vein used in situ as an arterial shunt after extirpation of the vein valves. A preliminary report. Surgery 51:492–495

    PubMed  CAS  Google Scholar 

  22. Hirsch AT, Haskal ZJ, Hertzer NR et al (2005) 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; ACC/AHA Task Force on Practice Guidelines; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary 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. J Am Coll Cardiol 47:1239–312

    Article  Google Scholar 

  23. Korte W, Cattaneo M, Chassot PG et al (2011) Peri-operative management of antiplatelet therapy in patients with coronary artery disease: joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (OGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC). Thromb Haemost 105:743–749

    Article  PubMed  CAS  Google Scholar 

  24. Kunlin J (1951) Long vein transplantation in treatment of ischemia caused by arteritis. Rev Chir 70:206–235

    PubMed  CAS  Google Scholar 

  25. Lexer E (1907) Die ideale Operation des arteriellen und des arteriello-venösen Aneurysma. Arch Klin Chir 83:459–477

    Google Scholar 

  26. Lundgren F, Dahllof AG, Schersten T et al (1989) Muscle enzyme adaptation in patients with peripheral arterial insufficiency: spontaneous adaptation, effect of different treatments and consequences on walking performance. Clin Sci (Lond) 77:485–493

    Google Scholar 

  27. McCollum CN, Devine CM (2003) The North West Femoro-Popliteal Trial Participants. Heparin bonded dacron or polytetrafluoroethylene for femoro-popliteal bypass: Five year results of a prospective randomised multi-centre clinical trial. J Vasc Surg 40:924–933

    Google Scholar 

  28. Melliere D, Desgrange P, Allaire E et al (2007) Long-term results of venous bypass for lower extremity arteries with selective short segment prosthetic reinforcement of varicose dilatations. Ann Vasc Surg 21:45–49

    Article  PubMed  Google Scholar 

  29. 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):1–75

    Article  Google Scholar 

  30. Nunn DB, Bunzendahl H, Handy JR (1994) Ernst Jeger: a forgotten pioneer in cardiovascular surgery. Surgery 116:569–575

    PubMed  CAS  Google Scholar 

  31. Perry MO (1993) John Hunter–triumph and tragedy. J Vasc Surg 17:7–14

    Article  PubMed  CAS  Google Scholar 

  32. Ploeg AJ, Lardenoye JW, Vrancken Peeters MP et al (2005) Contemporary series of morbidity and mortality after lower limb amputation. Eur J Vasc Endovasc Surg 29:633–637

    Article  PubMed  CAS  Google Scholar 

  33. Poldermans D, Boersma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341:1789–1794

    Article  PubMed  CAS  Google Scholar 

  34. Prince MR, Meaney JF (2006) Expanding role of MR angiography in clinical practice. Eur Radiol 16 (Suppl 2):B3–B8

    Article  PubMed  Google Scholar 

  35. Pringle JH (1913) Two cases of vein grafting for the maintenance of a direct arterial circulation. Lancet 1:1795–1796

    Article  Google Scholar 

  36. Scheffler P, Gross J, Dabringhaus S et al (1994) Noninvasive studies of macro- and microcirculation in follow-up of femoropopliteal bypass operation in IIb peripheral arterial occlusive disease. Vasa 23:312–320

    PubMed  CAS  Google Scholar 

  37. Schulman Ml, Badhey MR, Yatco R et al (1986) An 11-year experience with deep leg veins as femoropopliteal bypass grafts. Arch Surg 121:1010–1015

    PubMed  CAS  Google Scholar 

  38. Smith RB 3rd (1998) The foundations of modern aortic surgery. J Vasc Surg 27:7–15

    Article  PubMed  Google Scholar 

  39. Szilagyi DE, Smith RF, Derusso FJ et al (1966) Contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg 164:678–699

    Article  PubMed  CAS  Google Scholar 

  40. Taylor LM Jr, Edwards JM, Brant B et al (1987) Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein. Am J Surg 153:505–510

    Article  PubMed  Google Scholar 

  41. Taylor SM, Langan EM 3rd, Snyder BA et al (1997) Superficial femoral artery eversion endarterectomy: a useful adjunct for infrainguinal bypass in the presence of limited autogenous vein. J Vasc Surg 26:439–445, discussion 445–436

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  43. Vukobratov V, Kacanski M, Pasternak J et al (2006) Femoro-popliteal reconstructions: „in situ“ versus „reversed“ technique: comparative results. Med Pregl 59:360–364

    Article  PubMed  Google Scholar 

  44. Yao JST (1998) Historical perspectives: the 100th anniversary of the first arterial anastomosis in a human. In: Yao JST, Pearce WH (Hrsg) Techniques in Vascular and Endovascular Surgery. Appleton & Lange, Stamford

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Gefäß- und Endovascular-Chirurgie, Klinikum der Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai-7, 60590, Frankfurt am Main, Deustchland

    M. Keese, P. Bihari, M. Meyn, T. Schmandra & T. Schmitz-Rixen

Authors
  1. M. Keese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Bihari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Meyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Schmandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Schmitz-Rixen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Keese.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keese, M., Bihari, P., Meyn, M. et al. Periphere Bypasschirurgie der unteren Extremität. Z Herz- Thorax- Gefäßchir 25, 266–275 (2011). https://doi.org/10.1007/s00398-011-0878-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-011-0878-2

Schlüsselwörter

Keywords

Search

Navigation