Femorodistale Bypasschirurgie

Trotz der großen Fortschritte in der endovaskulären Behandlung peripherer Gefäßverschlüsse bleibt die Bypassanlage zu den Unterschenkel- und Fußarterien ein unverzichtbarer Bestandteil der Revaskularisationstechniken. Für den Erfolg sind eine sorgfältige Planung, individuelle Anpassung und die Einhaltung grundlegender Prinzipien entscheidend. Die Möglichkeiten einer individuellen Bypassversorgung werden an typischen Fallbeispielen erläutert.

Kernaussagen

• Trotz endovaskulärer Fortschritte ist der femorodistale Bypass mit autologer Vene weiterhin unverzichtbar für die Behandlung der CLTI mit überlegener Offenheits- und Beinerhaltungsrate.

• Der Erfolg hängt von präziser Bildgebung, Beurteilung des Einstroms und des Abstroms sowie einer auf den Einzelfall zugeschnittenen Anastomosenstrategie ab.

• Die APF bietet eine sinnvolle Alternative zur AFC, besonders bei limitierter Venenlänge oder voroperierter Leiste.

• Bei multipel voroperierter Leistenregion sollte eine komplette Rekonstruktion (z.B. mit bovinem Interponat) in Betracht gezogen werden, um klare anatomische Verhältnisse zu schaffen.

• Auch bereits mit Stents versorgte Gefäße können bei limitiertem autologem Material als zentrale Anastomosenregion dienen – mit speziellen Techniken zur Blutungskontrolle.

• Bei fehlender VSM sind zusammengesetzte Bypässe aus Armvenen (VC, VB) eine effektive Option mit guten Langzeitergebnissen.

• Valvulotomie, Blutleere, distale Anastomosentechniken und sorgfältiger Wundverschluss sind entscheidend für Funktion, Infektionsprophylaxe und Langzeiterfolg.

Schlüsselwörter

kritische Extremitätenischämie - peripherer Bypass - autologe Vene - Implantat

Keywords

peripheral bypass - autologous vein - anastomosis - technique - results

Publication History

Article published online:
01 September 2025

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