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Verschlusskrankheit der A. iliaca interna

Endovaskuläre Therapieoptionen

Occlusive disease of the internal iliac artery

Endovascular treatment options

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Zusammenfassung

Durch die Zunahme der peripheren arteriellen Verschlusskrankheit (PAVK) weltweit, mit einer Prävalenz von inzwischen 10–25 % bei 65- bis 80-Jährigen, nimmt auch die proximale PAVK unter Beteiligung der A. iliaca interna (AII) zu. Gleichzeitig existieren weder nationale noch internationale Leitlinien und Empfehlungen zum optimalen therapeutischen Management von Verschlussprozessen der AII – folglich fehlen konsentierte Algorithmen zur Diagnostik und Therapie.

Verschlussprozesse an der A. iliaca interna sind häufig symptomfrei, da ein ausgedehntes Kollateralsystem zur Gegenseite sowie zu femoralen, lumbalen und mesenterialen Gefäßen besteht. Klinisch wird die Erkrankung meist durch eine Gefäßclaudicatio und/oder vaskuläre Impotenz symptomatisch. Es kommt oft zu einer zeitlichen Latenz in der Diagnosestellung, weil gerade bei isolierten Veränderungen an der AII Schwierigkeiten in der Diagnostik bestehen können.

Eine invasive Behandlung der proximalen AII kann sowohl offen-chirurgisch als auch endovaskulär erfolgen. Distal revaskularisierende Maßnahmen an den parietalen und viszeralen Endästen erfordern den Einsatz endovaskulärer Techniken. In der Literatur werden dabei hohe technische Erfolgsraten und akzeptable Offenheitsraten für die endovaskuläre Therapie beschrieben, die leider nicht immer mit dem klinischen Erfolg korrelieren.

Dieser Artikel beschreibt minimal-invasive Therapiekonzepte und Techniken zur direkten und indirekten Revaskularisierung der pelvinen Zirkulation. Die Darstellung erfolgt anhand eigener retrospektiv ausgewählter Fälle. Besonderheiten der Eingriffsplanung und Durchführung werden, ebenso wie offene Diskussionspunkte und Fragen, vor dem Hintergrund der aktuellen Literatur dargestellt und diskutiert.

Abstract

Due to the increase of peripheral artery disease (PAD) worldwide with a prevalence of 10–25% in patients aged 65–80 years, proximal PAD with involvement of the internal iliac artery (IIA) is also increasing. At the same time no national or international guidelines for the optimal management of occlusive processes of the IIA exist, consequently, there are no approved algorithms for optimal diagnostics and treatment. Occlusive processes of the IIA are often asymptomatic due to the extensive contralateral collateral system and to the femoral, lumbar and mesenteric arteries. Clinically, gluteal claudication and vascular impotence are the leading symptoms in symptomatic patients. There is often a significant time delay between the onset of symptoms and diagnosis because difficulties in the diagnostics can arise, especially in isolated alterations of the IIA. Open surgical or endovascular approaches can be carried out for invasive treatment of proximal IIA lesions but measures for revascularization of distal lesions of parietal and visceral terminal branches require endovascular techniques. High rates of technical success and acceptable patency rates have been reported in the literature for endovascular management of IAA lesions; however, these do not always correlate with the clinical success. This article describes minimally invasive treatment strategies and techniques for direct and indirect revascularization of the pelvic circulation based on own retrospectively selected cases. Characteristics of planning and performing IIA procedures as well as unsolved problems and open questions are presented and discussed in the context of the currently available literature.

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Authors and Affiliations

  1. Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Gefäßmedizin, Universitätskrankenhaus Eppendorf, Martinistr. 52, 20152, Hamburg, Deutschland

    S. W. Carpenter, G. Panuccio, E. S. Debus, T. Kölbel & A. Larena-Avellaneda

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Correspondence to S. W. Carpenter.

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S. W. Carpenter, G. Panuccio, E. S. Debus, T. Kölbel und A. Larena-Avellaneda geben an, dass kein Interessenkonflikt besteht.

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Carpenter, S.W., Panuccio, G., Debus, E.S. et al. Verschlusskrankheit der A. iliaca interna. Gefässchirurgie 24, 295–305 (2019). https://doi.org/10.1007/s00772-019-0538-5

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