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Chirurgische und interventionelle Behandlung der chronisch-kritischen Beinischämie

Surgical and interventional treatment of chronic critical limb ischemia

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Zusammenfassung

Die chronisch-kritische Beinischämie (CLI) ist die schwerste Form der peripher-arteriellen Verschlusskrankheit und geht mit einem erhöhten Risiko für letale kardiovaskuläre Ereignisse einher. Die meisten Patienten überleben aber die ersten Jahre nach Diagnosestellung und sind für den Erhalt ihrer Selbständigkeit auf eine nachhaltige Verbesserung der Beindurchblutung angewiesen. Dieser CME-Artikel fasst die chirurgischen und endovaskulären Optionen zur Revaskularisierung zusammen und geht auf deren Nachhaltigkeit bei CLI ein. Grenzen der verfügbaren Evidenz werden aufgezeigt. Sie beruhen vor allem auf dem Fehlen einer einheitlichen Definition des Behandlungserfolges. Ein klinisch orientierter Lösungsvorschlag wird diskutiert, der helfen könnte, die verschiedenen Behandlungsindikationen zu schärfen. Da sich aber nur die wenigsten Patienten gleich gut für verschiedene Verfahren eignen, werden CLI-Patienten auch in Zukunft am besten in einem interdisziplinär arbeitenden Team betreut sein.

Abstract

Chronic critical limb ischemia (CLI) represents the most severe form of peripheral arterial occlusive disease and is associated with an increased risk for fatal cardiovascular events. However, most patients survive the first years after diagnosis and, to remain independent, depend on durable improvement of limb perfusion. This CME article summarizes the various surgical and endovascular options of revascularization in the context of CLI and discusses their durability. Available evidence is limited which is mainly due to a lack of a generally accepted outcome definition of clinical treatment success. A recently proposed clinically driven measure of success is discussed and how its use could improve definition of specific indications. As only few patients are clinically equally suitable for various treatment options, CLI patients will certainly remain to be managed best within interdisciplinary teams with close collaboration between surgeons and interventionalists.

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Authors and Affiliations

  1. Schweizer Herz- und Gefässzentrum, Klinik für Herz- und Gefässchirurgie, Universitätsspital Bern, Inselspital, 3010, Bern, Schweiz

    F. Dick & R. von Allmen

  2. Klinik für klinische und interventionelle Angiologie, Universitätsspital Bern, Inselspital, Bern, Schweiz

    N. Diehm

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  1. F. Dick
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  2. R. von Allmen
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  3. N. Diehm
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Correspondence to F. Dick.

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Dick, F., von Allmen, R. & Diehm, N. Chirurgische und interventionelle Behandlung der chronisch-kritischen Beinischämie. Gefässchirurgie 16, 55–70 (2011). https://doi.org/10.1007/s00772-010-0863-1

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  • DOI: https://doi.org/10.1007/s00772-010-0863-1

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