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Aktuelle Kardiologie 2014; 3(1): 27-31
DOI: 10.1055/s-0033-1357883
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Update – interventionelle Therapie der pAVK

Update – Interventional Therapy of PAD
E. Blessing
Medizinische Klinik III, Universität Heidelberg
,
B. Vogel
Medizinische Klinik III, Universität Heidelberg
› Author Affiliations
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Publication History

Publication Date:
28 February 2014 (online)

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Zusammenfassung

In den letzten Jahren hat sich der Trend zur überwiegend endovaskulären Revaskularisation bei Patienten mit pAVK weiter fortgesetzt. Aufgrund der hohen technischen Erfolgsrate und der geringen Komplikationsquote stellen Interventionen in der weit überwiegenden Zahl der Fälle die Methode der Wahl dar. Die Indikation zur Revaskularisation besteht bei Läsionen der Beckenarterien sowie der femoropoplitealen Strombahn im Stadium der Claudicatio, bei infrapoplitealen Stenosen bzw. Verschlüssen in erster Linie im Stadium der kritischen Ischämie bzw. bei diabetischem Fußsyndrom. Die Behandlungsstrategie sollte immer interdisziplinär abgestimmt werden, idealerweise sollte die Behandlung innerhalb von Gefäßzentren erfolgen. Die wesentliche Limitation der Interventionen ist nach wie vor das Auftreten von Restenosen bzw. Wiederverschlüssen; diese sind insbesondere bei infrapoplitealen Läsionen nach wie vor unbefriedigend. Einen deutlichen Fortschritt bringt der Einsatz von medikamentenbeschichteten Ballons, wodurch in der femoropoplitealen Strombahn die Notwendigkeit von Reinterventionen erfreulich reduziert werden konnte. Eine mögliche sinnvolle Behandlungsalternative könnten künftig bioresorbierbare Scaffolds bieten sowie der Einsatz von Kombinationstherapien wie z. B. eine Plaqueentfernung mittels Atherektomie mit anschließender DEB-Angioplastie, wobei hierbei auch ökonomische Gesichtspunkte zu beachten sein werden.

Abstract

In the past years, there was an increasing trend towards endovascular therapy for patients with peripheral arterial disease. Due to the high technical success and low complication rate, interventions are the method of choice in the majority of cases. The rationale for revascularization are impaired walking capacity for iliac and femoropopliteal lesions and critical limb ischemia or diabetic foot syndrome for infrapopliteal lesions. Ideally, treatment strategy is done as a multidisciplinary approach within a dedicated vascular center. Restenosis or reocclusion remain a major limitation of endvascular therapy, in particular in lesions below the knee. A major breakthrough was the introduction of drug eluting balloons, in particular in femoropopliteal lesions, where repeated revascularizations could be significantly reduced. Bioresorbable vascular scaffolds or combination therapies such as plaque excision followed by drug eluting ballon technology might arise as future strategies. However, economic issues have also to be kept in mind in that respect.

Schlüsselwörter

pAVK - Claudicatio intermittens - kritische Ischämie - interventionelle Therapie

Key words

peripheral arterial disease - claudication - critical limb ischemia - interventional therapy
 

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