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Versagen von PTA- und Stenttherapie in der popliteokruralen Region

Extremitätenerhalt durch femorodistale Bypasschirurgie – ein Bericht über 5 Fälle

Failure of PTA and stents in the tibial arteries: five cases of extremity salvage using femorodistal bypass surgery

Limb salvage by tibial Bypass Surgery – a report of 5 cases

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Zusammenfassung

Einleitung

Die perkutane transluminale Angioplastie (PTA) und Stents in der A. poplitea und den Unterschenkelarterien werden immer häufiger bei der schweren AVK angewandt, allerdings mit meist nur kurzfristig gutem Ergebnis.

Patienten

In 5 Fällen mit AVK bzw. Aneurysma der popliteokruralen Region war es nach PTA und Stents innerhalb von 2–8 Monaten zur arteriellen Thrombose und kritischen Ischämie gekommen.

Ergebnisse

Eine differenzierte krurale Bypasschirurgie konnte bei 4 Patienten die Extremität retten, bei einem Patienten musste trotz Arterialisation des venösen Systems als Ultima Ratio letztlich eine Unterschenkelamputation durchgeführt werden.

Schlussfolgerung

Wie hier an 5 Fällen demonstriert, ist eine Stenttherapie bei ausgedehnter AVK der kruralen Arterien und auch beim Popliteaaneurysma nicht dauerhaft und beim derzeitigen Stand der Stenttechnologie – auch mit Drug-eluting-Stents – noch nicht zu empfehlen. Momentan ist in den meisten Fällen die subtile krurale und pedale Bypasschirurgie vorzuziehen.

Abstract

Purpose

Percutaneous transluminal angioplasty (PTA) and stenting in the popliteal and tibial arteries is gaining widespread acceptance in spite of poor results compared to tibial and pedal bypass surgery.

Methods

Five patients with severe arterial occlusive disease having PTA and stents in the popliteal and tibial region developed arterial thrombosis and critical limb ischemia only 2–8 months after the procedure. Femorodistal bypass surgery was performed for limb salvage.

In four patients, limb salvage was achieved by appropriate distal bypass surgery. In one patient, after stent related thrombosis of the last pedal artery, arterialization of the foot veins was performed but failed to improve the ischemia. This patient sustained a below knee amputation.

Conclusion

The good results of endovascular tools for the appropriate functioning in coronary arteries are not transferable to the peripheral vasculature despite a similar size of the tibial arteries. Some patients with limited occlusive arterial disease and focal lesions will be suitable for endovascular treatment, but the majority of patients will require meticulous tibial bypass surgery for limb salvage.

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Authors and Affiliations

  1. Klink für Herz-, Thorax- und Gefäßchirurgie, Johannes-Gutenberg-Universität Mainz

    B. Dorweiler, J. Reinstadler, C. F. Vahl & A. Neufang

  2. Klinik für Radiologie, Johannes-Gutenberg-Universität Mainz

    M. B. Pitton, S. Herber & J. Schneider

  3. II. Medizinische Klinik, Johannes-Gutenberg-Universität Mainz

    C. Espinola-Klein & S. Savvidis

  4. Klinik für Herz-, Thorax- und Gefäßchirurgie, Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz

    W. Schmiedt

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  1. W. Schmiedt
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  2. B. Dorweiler
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  3. J. Reinstadler
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  4. M. B. Pitton
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  5. S. Herber
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  6. J. Schneider
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  7. C. Espinola-Klein
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  9. C. F. Vahl
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  10. A. Neufang
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Correspondence to W. Schmiedt.

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Schmiedt, W., Dorweiler, B., Reinstadler, J. et al. Versagen von PTA- und Stenttherapie in der popliteokruralen Region. Gefässchirurgie 11, 271–280 (2006). https://doi.org/10.1007/s00772-006-0453-4

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  • DOI: https://doi.org/10.1007/s00772-006-0453-4

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