Zusammenfassung.
Der Langzeiterfolg infrainguinaler Bypässe wird vor allem durch Anastomosenstenosen,
seltener durch Stenosen im Bypass selbst, bestimmt. Neben exakten Operationstechniken
ist deshalb eine regelmäßige postoperative Überwachung des Bypasses zur Verbesserung
der Langzeitdurchgängigkeit allgemein akzeptiert. Zur Identifizierung von bypassgefährdenden
Stenosen hat die Duplexsonographie als Untersuchungsmodalität der Wahl einen fixen
Stellenwert erlangt. Die perkutane transluminale Angioplastie (PTA) ist eine sinnvolle,
minimal invasive Alternative zur offenen chirurgischen Revision von erstmalig aufgetretenen
kurzstreckigen und singulären Bypassstenosen respektive Anastomosenstenosen. Primär
technische Erfolgsraten nach PTA werden bis zu 100 %, primär assistierte 5-Jahres-Offenheitsraten
bis zu 65 % angegeben. Die intraarterielle Thrombolyse bei Bypassthrombosen ist mit
bis zu 92 %iger technischer Erfolgsrate von manchen Arbeitsgruppen als primäre Therapie
favorisiert. Bei geringer Traumatisierung der Wand von Venenbypässen im Vergleich
zur chirurgischen Thrombektomie mit dem Fogarty-Katheter, liegen weitere Vorteile
in der Fibrinolyse von Thromben in Ausstromgefässen und der Demaskierung von Stenosen,
welche gezielt einer PTA oder auch einer chirurgischen Revision zugeführt werden können.
Interventions in infrainguinal bypass grafts.
The long-term success of infrainguinal bypass grafts depends on meticulous surgical
technique and a periodic program of postoperative surveillance. Duplex scanning is
the method of choice for the detection of stenotic lesions that threaten graft patency.
As an alternative to surgery, PTA is gaining increasing acceptance for the treatment
of non-recurrent, short, and single stenotic lesions, despite somewhat controversial
opinions. The initial technical success rates for PTA were reported to be up to 100
%, and a 5-year primary assisted patency rate of up to 65 % has been achieved. Some
authors favorize intra-arterial infusion of fibrinolytic agents for the treatment
of bypass graft occlusion with technical success rates of up to 92 %. In addition
to a reduced trauma compared to surgical thrombectomy, of the venous wall the advantage
of thrombolytic therapy is clot lysis in run-off vessels, and uncovering of the stenotic
lesions. This stenosis may then be treated by an endovascular or surgical approach.
Schlüsselwörter:
Infrainguinale Bypässe - Drohendes Bypassversagen - Bypassverschluss - PTA - Fibrinolyse
Key words:
Infrainguinal bypass grafts - Failing graft - Occlusion - PTA - Lysis
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Dr. M. Schoder
Abt. für Angiographie und
Interventionelle Radiologie
Univ.-Klinik für Radiodiagnostik
Währinger Gürtel 18 - 20
1090 Wien
Austria
