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Dtsch Med Wochenschr 2023; 148(20): 1301-1306
DOI: 10.1055/a-2017-7786
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Interventionelle Therapie der peripheren arteriellen Verschlusskrankheit

Endovascular therapy for peripheral arterial disease
Tanja Böhme
,
Thomas Zeller
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Die Behandlungsziele für Patienten mit einer peripheren arteriellen Verschlusskrankheit (PAVK) unterscheiden sich je nach Stadium der Erkrankung. Neben der konservativen Therapie mit intensivem Gehtraining haben die endovaskuläre und die offene gefäßchirurgische Revaskularisation einen hohen Stellenwert. Im Folgenden werden die zur Verfügung stehenden, gebräuchlichen endovaskulären Verfahren nach betroffenem Gefäßsegment diskutiert.

Abstract

In addition to conservative therapy with intensive walking training, endovascular revascularisation and open vascular surgical revascularisation are of high importance in the treatment of peripheral arterial disease. Over the past decades, endovascular therapy has developed considerably and is now the treatment of choice for most vascular segments. The use of different devices has been shown to be beneficial for different vessel segments. Primary stent angioplasty has been shown to be superior to balloon angioplasty with secondary stent implantation for the treatment of iliac lesions. Femoropopliteal, the use of paclitaxel-eluting balloon angioplasty is recommended. A mortality signal shown in a meta-analysis was not confirmed. With directional atherectomy and intravascular lithotripsy, different options for plaque modification are available. The cytostatic drug sirolimus as another antirestenotic substance still has to be investigated in large, randomised trials. A final assessment of the effectiveness and safety is not yet possible. Infrapopliteal balloon angioplasty remains the standard treatment. After interventional therapy, regular follow-up is recommended.

Kernaussagen

  • Neben der konservativen Therapie mit intensivem Gehtraining haben die endovaskuläre Revaskularisation und die offene gefäßchirurgische Revaskularisation einen hohen Stellenwert in der Behandlung der PAVK.

  • Für isolierte iliakale Läsionen empfehlen die Leitlinien primär ein endovaskuläres Vorgehen. Die primäre Stentangioplastie hat sich gegenüber der Ballonangioplastie mit sekundärer Stentimplantation überlegen gezeigt.

  • Femoropopliteal wird der Einsatz der paclitaxelbeschichteten Ballonangioplastie empfohlen. Ein in einer Metaanalyse gezeigtes Mortalitätssignal bestätigte sich nicht.

  • Mit der direktionalen Atherektomie und der intravaskulären Lithotripsie stehen verschiedene Optionen zur Plaquemodifikation zur Verfügung.

  • Das Zytostatikum Sirolimus als weitere, antirestenotisch wirkende Substanz muss noch in größeren randomisierten Studien untersucht werden. Eine abschließende Beurteilung zur Effektivität und Sicherheit ist noch nicht möglich.

Infrapopliteal ist die Ballonangioplastie nach wie vor die Standardtherapie.

Schlüsselwörter

Periphere arterielle Verschlusskrankheit - endovaskuläre Therapie - Stentangioplastie - Ballonangioplastie - medikamentenbeschichtet

Keywords

Peripheral arterial disease - endovascular therapy - stent angioplasty - balloon angioplasty - drug-coated


Publication History

Article published online:
27 September 2023

© 2023. Thieme. All rights reserved.

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