Revaskularisation und Amputationsrisiko bei pAVK und Diabetes mellitus

Zusammenfassung

Die periphere arterielle Verschlusskrankheit (pAVK) ist die Manifestation der Atherosklerose an den peripheren Arterien der Extremitäten. Diabetes mellitus (DM) ist ein Risikofaktor für pAVK und ein Prädiktor für Fußläsionen, die das Risiko für eine Amputation drastisch erhöhen. Neben einer fachgerechten Wundbehandlung und Optimierung der Risikofaktoren ist eine Revaskularisation bei DM und Ischämie ein essenzieller Bestandteil der Therapie zur Verhinderung einer Amputation.

Publication History

Article published online:
18 November 2025

• Literatur

• 1 Fowkes FG, Rudan D, Rudan I. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329-1340
• 2 Malyar NM, Freisinger E, Meyborg M. Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complications 2016; 30: 1117-1122
• 3 Diehm C, Schuster A, Allenberg JR. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95-105
• 4 Silvestro A, Diehm N, Savolainen H. Falsely high ankle-brachial index predicts major amputation in critical limb ischemia. Vasc Med 2006; 11: 69-74
• 5 Hinchliffe RJ, Forsythe RO, Apelqvist J. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36: e3276
• 6 Balletshofer B, Böckler D, Diener H. Positionspapier zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (pAVK) bei Menschen mit Diabetes mellitus. Diabetol Stoffwechs 2023; 18: S370-S380
• 7 Schaper NC, van Netten JJ, Apelqvist J. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40: e3657
• 8 Malyar N, Behrendt CA, Espinola-Klein C. et al. S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. Vasa 2025; 54 S113 1-119
• 9 Mills Sr JL, Conte MS, Armstrong DG. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014; 59: 220-34 e1
• 10 Aboyans V, Ricco JB, Bartelink MEL. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763-816
• 11 Conte MS, Bradbury AW, Kolh P. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg 2019; 58: S1-S109 e33
• 12 Fitridge R, Chuter V, Mills J. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer. J Vasc Surg 2023; 78: 1101-1131
• 13 Menard MT, Farber A, Assmann SF. Design and rationale of the best endovascular versus best surgical therapy for patients with critical limb ischemia (BEST-CLI) Trial. J Am Heart Assoc 2016; 5: e003219
• 14 Popplewell MA, Davies H, Jarrett H. Bypass versus angio plasty in severe ischaemia of the leg – 2 (BASIL-2) trial: study protocol for a randomised controlled trial. Trials 2016; 17: 11
• 15 Hunt BD, Popplewell MA, Davies H. Balloon versus stenting in severe ischaemia of the leg-3 (BASIL-3): study protocol for a randomised controlled trial. Trials 2017; 18: 224
• 16 Senneville É, Albalawi Z, van Asten SA. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev 2024; 40: e3687
• 17 Lawall H, Pokrovsky A, Checinski P. Efficacy and safety of alprostadil in patients with peripheral arterial occlusive disease fontaine stage IV: results of a placebo controlled randomised multicentre trial (ESPECIAL). Eur J Vasc Endovasc Surg 2017; 53: 559-566
• 18 Bonaca MP, Bauersachs RM, Anand SS. Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med 2020; 382: 1994-2004
• 19 Korosoglou G, Giusca S, Langhoff R. Safety and effectiveness of endovascular therapy for the treatment of peripheral artery disease in patients with and without diabetes mellitus. Angiology 2022; 73: 956-966
• 20 Freisinger E, Malyar NM, Reinecke H. Impact of diabetes on outcome in critical limb ischemia with tissue loss: a large-scaled routine data analysis. Cardiovasc Diabetol 2017; 16: 41
• 21 Faglia E, Clerici G, Clerissi J. Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care 2009; 32: 822-827
• 22 Reinecke H, Unrath M, Freisinger E. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J 2015; 36: 932-938
• 23 Makowski L, Engelbertz C, Köppe J. Contemporary treatment and outcome of patients with ischaemic lower limb amputation: a focus on sex differences. Eur J Vasc Endovasc Surg 2023; 66: 550-559