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.
Schlüsselwörter
Periphere arterielle Verschlusskrankheit - endovaskuläre Therapie - Stentangioplastie
- Ballonangioplastie - medikamentenbeschichtet
Keywords
Peripheral arterial disease - endovascular therapy - stent angioplasty - balloon angioplasty
- drug-coated
