Skip to main content

Akute Verschlussprozesse im Extremitätenbereich: Perkutane Thrombektomie und lokale Thrombolyse

  • Chapter
  • First Online:
Operative und interventionelle Gefäßmedizin

Part of the book series: Springer Reference Medizin ((SRM))

  • 409 Accesses

Zusammenfassung

Die akute Extremitätenischämie ist eine Notfallsituation mit einer hohen Morbidität und Mortalität. Die Therapie stellt für die beteiligten Fachdisziplinen eine interdisziplinäre Herausforderung dar. Entscheidend ist, nachdem die Diagnose verifiziert und konservative Maßnahmen eingeleitet wurden, eine rasche Revaskularisation, wobei die Wahl des Therapieverfahrens von der Verfügbarkeit einer der Optionen sowie vom Schweregrad der Ischämie abhängt. Patienten mit einer inkompletten Ischämie (Kategorie I–IIa) profitieren gleichermaßen von einer chirurgischen wie von einer perkutanen Revaskularisationsmaßnahme, wobei minimal-invasive Methoden Vorteile in Hinblick auf Morbidität und Mortalität aufweisen. Neben der lokoregionalen Lysetherapie gehören weitere perkutane Optionen wie die Aspirationsthrombektomie sowie die perkutane mechanische Thrombektomie zum Arsenal eines endovaskulären Interventionalisten.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 389.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 399.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Alfke H, Geks J, Wagner HJ (2003) Radiological diagnosis and treatment of acute limb ischemia. Chirurg 74(12):1110–1117

    Article  CAS  Google Scholar 

  • Allie DE, Hebert CJ, Lirtzman MD, Wyatt CH, Keller VA, Khan MH, Barker EA, McElderry MW, Khan MA, Fail PS, Stagg SJ 3rd, Mitran EV, Chaisson G, Allie SD, Allie AA, Walker CM (2004) Novel simultaneous combination chemical thrombolysis/rheolytic thrombectomy therapy for acute critical limb ischemia: the power-pulse spray technique. Catheter Cardiovasc Interv 63(4):512–522

    Article  Google Scholar 

  • Baril DT, Ghosh K, Rosen AB (2014) Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg 60(3):669–677, e662

    Article  Google Scholar 

  • Braithwaite BD, Buckenham TM, Galland RB, Heather BP, Earnshaw JJ (1997) Prospective randomized trial of high-dose bolus versus low-dose tissue plasminogen activator infusion in the management of acute limb ischaemia. Thrombolysis Study Group. Br J Surg 84(5):646–650

    Article  CAS  Google Scholar 

  • Dukkipati R, Yang EH, Adler S, Vintch J (2009) Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Nat Clin Pract Nephrol 5(2):112–116

    Article  Google Scholar 

  • Gupta R, Hennebry TA (2012) Percutaneous isolated pharmaco-mechanical thrombolysis-thrombectomy system for the management of acute arterial limb ischemia: 30-day results from a single-center experience. Catheter Cardiovasc Interv 80(4):636–643

    Article  Google Scholar 

  • Hundt W, Kalinowski M, Stamm AC, Portig I, Swaid Z, Dietz C, Geks J, Burbelko M (2013) Combined treatment of subacute and acute synthetic and venous bypass-graft occlusions with percutaneous mechanical thrombectomy and thrombolysis. Eur J Radiol 82(12):e807–e815

    Article  Google Scholar 

  • Karnabatidis D, Spiliopoulos S, Tsetis D, Siablis D (2011) Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol 34(6):1123–1136

    Article  Google Scholar 

  • Lawall H, Diehm C (2009) Leitlinien zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (PAVK). Vasa 38(Suppl 75):4–72

    Article  Google Scholar 

  • Leung DA, Blitz LR, Nelson T, Amin A, Soukas PA, Nanjundappa A, Garcia MJ, Lookstein R, Simoni EJ (2015) Rheolytic pharmacomechanical thrombectomy for the management of acute limb ischemia: results from the PEARL registry. J Endovasc Ther 22(4):546–557

    Article  Google Scholar 

  • Lichtenberg M (2010) Percutaneous mechanical thrombectomy by means of rotational thrombectomy. Current study situation. Med Klin (Munich) 105(10):705–710

    Article  Google Scholar 

  • McNamara TO, Fischer JR (1985) Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase. AJR Am J Roentgenol 144(4):769–775

    Article  CAS  Google Scholar 

  • Meyerovitz MF, Goldhaber SZ, Reagan K, Polak JF, Kandarpa K, Grassi CJ, Donovan BC, Bettmann MA, Harrington DP (1990) Recombinant tissue-type plasminogen activator versus urokinase in peripheral arterial and graft occlusions: a randomized trial. Radiology 175(1):75–78

    Article  CAS  Google Scholar 

  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K (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 

  • Ouriel K, Kandarpa K (2004) Safety of thrombolytic therapy with urokinase or recombinant tissue plasminogen activator for peripheral arterial occlusion: a comprehensive compilation of published work. J Endovasc Ther 11(4):436–446

    Article  Google Scholar 

  • Ouriel K, Kandarpa K, Schuerr DM, Hultquist M, Hodkinson G, Wallin B (1999) Prourokinase versus urokinase for recanalization of peripheral occlusions, safety and efficacy: the PURPOSE trial. J Vasc Interv Radiol 10(8):1083–1091

    Article  CAS  Google Scholar 

  • Ouriel K, Shortell CK, DeWeese JA, Green RM, Francis CW, Azodo MV, Gutierrez OH, Manzione JV, Cox C, Marder VJ (1994) A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia. J Vasc Surg 19(6):1021–1030

    Article  CAS  Google Scholar 

  • Ouriel K, Veith FJ, Sasahara AA (1998) A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or peripheral arterial surgery (TOPAS) Investigators. N Engl J Med 338(16):1105–1111

    Article  CAS  Google Scholar 

  • Patel N, Sacks D, Patel RI, Moresco KP, Ouriel K, Gray R, Ambrosius WT, Lewis CA (2003) SIR reporting standards for the treatment of acute limb ischemia with use of transluminal removal of arterial thrombus. J Vasc Interv Radiol 14(9 Pt 2):453–465

    Article  Google Scholar 

  • Patel NH, Krishnamurthy VN, Kim S, Saad WE, Ganguli S, Walker TG, Nikolic B (2013) Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia. J Vasc Interv Radiol 24(1):3–15

    Article  Google Scholar 

  • Robertson I, Kessel DO, Berridge DC (2010) Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev 3:Cd001099

    Google Scholar 

  • Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26(3):517–538

    Article  CAS  Google Scholar 

  • Schleder S, Diekmann M, Manke C, Heiss P (2015) Percutaneous aspiration thrombectomy for the treatment of arterial thromboembolic occlusions following percutaneous transluminal angioplasty. Cardiovasc Intervent Radiol 38(1):60–64

    Article  Google Scholar 

  • Schrijver A, Vos J, Hoksbergen AW, Fioole B, Fritschy W, Hulsebos R, De Jong S, Reijnen MM, De Vries JP (2011) Ultrasound-accelerated thrombolysis for lower extremity ischemia: multicenter experience and literature review. J Cardiovasc Surg (Torino) 52(4):467–476

    CAS  Google Scholar 

  • Semba CP, Bakal CW, Calis KA, Grubbs GE, Hunter DW, Matalon TA, Murphy TP, Stump DC, Thomas S, Warner DL (2000) Alteplase as an alternative to urokinase. Advisory panel on catheter-directed thrombolytic therapy. J Vasc Interv Radiol 11(3):279–287

    Article  CAS  Google Scholar 

  • Starck EE, McDermott JC, Crummy AB, Turnipseed WD, Acher CW, Burgess JH (1985) Percutaneous aspiration thromboembolectomy. Radiology 156(1):61–66

    Article  CAS  Google Scholar 

  • STILE_Investigators (1994) Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg 220(3):251–266; discussion 266–258

    Article  Google Scholar 

  • Storck M, Wagner HJ (2007) Peripheral arterial obstruction and acute lower limb ischemia. Chirurg 78(7):611–619

    Article  CAS  Google Scholar 

  • Sullivan KL, Gardiner GA Jr, Shapiro MJ, Bonn J, Levin DC (1989) Acceleration of thrombolysis with a high-dose transthrombus bolus technique. Radiology 173(3):805–808

    Article  CAS  Google Scholar 

  • Swischuk JL, Fox PF, Young K, Hussain S, Smouse B, Castaneda F, Brady TM (2001) Transcatheter intraarterial infusion of rt-PA for acute lower limb ischemia: results and complications. J Vasc Interv Radiol 12(4):423–430

    Article  CAS  Google Scholar 

  • von Allmen RS, Anjum A, Powell JT, Earnshaw JJ (2015) Hospital trends of admissions and procedures for acute leg ischaemia in England, 2000–2011. Ann R Coll Surg Engl 97(1):59–62

    Article  Google Scholar 

  • Wagner HJ, Starck EE, Reuter P (1994) Long-term results of percutaneous aspiration embolectomy. Cardiovasc Intervent Radiol 17(5):241–246

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Michael Burbelko or H.-J. Wagner .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Burbelko, M., Wagner, HJ. (2020). Akute Verschlussprozesse im Extremitätenbereich: Perkutane Thrombektomie und lokale Thrombolyse. In: Debus, E., Gross-Fengels, W. (eds) Operative und interventionelle Gefäßmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53380-2_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-53380-2_14

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-53378-9

  • Online ISBN: 978-3-662-53380-2

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics