Zur operativen Therapie der peripheren arteriellen Verschlusskrankheit

Die chirurgische Therapie der peripheren arteriellen Verschlusserkrankung konzentriert sich neben der direkten Wiederherstellung der Femoralisbifurkation auf die periphere Bypassanlage, vor allem bei der chronischen amputationsbedrohenden Ischämie. Diese Methoden können mit vor- und nachgeschalteten endovaskulären Eingriffen in Form eines Hybrideingriffs kombiniert werden. Operative und endovaskuläre Eingriffe sind als komplementär zu betrachten.

Abstract

The surgical treatment of peripheral arterial occlusive disease focuses not only on the direct restoration of the femoral bifurcation but also on the peripheral bypass, especially in the case of chronic amputation-threatening ischemia. Comprehensive imaging is indispensable for planning surgical therapy. The local reconstruction of the femoral bifurcation offers very good long-term results and can be easily combined with endovascular methods. The peripheral bypass is the central pillar of surgical therapy, especially in CLTI. Autologous vein should always be the first-choice material. It delivers good long-term results in every position. Prosthetic material is only used if there is no vein and should be combined with autologous veins in the crural and pedal area if possible. The technical limit for a bypass system lies in the pedal arteries and their branches. These methods can be combined with upstream and downstream endovascular interventions in the form of a hybrid intervention. Surgical and endovascular interventions are to be considered as complementary.

Kernaussagen

• Zur Planung der operativen Therapie ist eine umfassende Bildgebung unverzichtbar.

• Die lokale Rekonstruktion der Femoralisbifurkation bietet sehr gute Langzeitergebnisse und ist gut mit endovaskulären Methoden kombinierbar.

• Der periphere Bypass ist die zentrale Säule der chirurgischen Therapie, vor allem bei der CLTI.

• Eine autologe Vene sollte immer Material der 1. Wahl sein. Sie liefert in jeder Position gute Langzeitergebnisse.

• Prothesenmaterial kommt nur bei fehlender Vene zur Anwendung und sollte im kruralen und pedalen Bereich nach Möglichkeit mit autologer Vene kombiniert werden.

• Die technische Grenze für eine Bypassanlage liegt an den pedalen Arterien und ihren Ästen.

Schlüsselwörter

chirurgische Therapie - peripheren arteriellen Verschlusskrankheit - Amputationsbedrohung - Femoralisbifurkation - Bypasschirurgie

Keywords

surgical therapy - peripheral arterial disease - amputation threat - femoral bifurcation - bypass surgery

Publikationsverlauf

Artikel online veröffentlicht:
27. September 2023

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