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Dtsch Med Wochenschr 2023; 148(20): 1293-1300
DOI: 10.1055/a-2017-7742
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Konservative Therapie und Sekundärprävention der pAVK

Conservative therapy and secondary prevention of PAD
Katja S. Mühlberg
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Der unmittelbare und langfristige Erfolg endovaskulärer und offen chirurgischer Revaskularisierungsverfahren wird entscheidend von der konservativen Therapie der pAVK bestimmt. Die „schonende, bewahrende“ Behandlung soll dabei als absolute Basistherapie verstanden werden, weil sie die „Big Five“ der Atherosklerose-Risikofaktoren adressiert. Dieser Beitrag präsentiert das Spektrum sowohl medikamentöser als auch nicht medikamentöser Strategien.

Abstract

Today, peripheral artery disease (PAD) is treated with the most modern endovascular and open surgical revascularisation procedures. But the short and long-term success of these interventions is decisively determined by the conservative therapy of PAD, which therefore represents the absolute basic therapy of every PAD. Conservative treatment addresses the "Big Five" of atherosclerosis risk factors: smoking, lack of exercise and overweight, diabetes, hypertension, and hyperlipidemia. Despite the knowledge that PAD as a peripheral manifestation of the systemic atherosclerosis needs the same risk factor management as e.g., coronary heart disease, not even every second PAD patient in Germany receives the required therapy. This paper presents the spectrum of both drug and non-drug strategies and focuses on aspects such as platelet inhibition and anticoagulation regimes, lipid-lowering options as well as the benefits and necessity of exercise programs to promote collaterals and improve quality of life by extending the pain-free walking distance. Proven strategies to overcome smoking addiction, use and purpose of vasoactive substances are highlighted as well as the potential risks of diabetic foot syndrome for limb salvage and prevention of wounds.

Kernaussagen

  • Die konservative Therapie ist bei jedem pAVK-Patienten indiziert, egal, ob als alleinstehende Option oder als Basistherapie interventioneller Verfahren.

  • Kurz- und langfristige Effekte endovaskulärer und chirurgischer Revaskularisationsverfahren hängen entscheidend von einem suffizienten Risikofaktoren-Management ab, das die „Big Five“ der Atherosklerose adressiert.

  • Die Komplexität der Risikofaktoren, die Koinzidenz mortalitätsbestimmender Erkrankungen sowie das breite Spektrum der medikamentösen Optionen machen die Angiologie zum zentralen internistischen Ansprechpartner für pAVK-Patienten.

  • Strukturierte Rehabilitationsmaßnahmen und die Integration psychosozialer Belange sind essenziell für Erhalt und Wiederherstellung der Lebensqualität Betroffener.

Schlüsselwörter

Gehtraining - Thrombozytenaggregationshemmer - Lipidsenker - Raucherentwöhnung

Keywords

walking training - platelet aggregation inhibitors - lipid-lowering drugs - smoking cessation


Publication History

Received: 31 May 2023

Accepted: 10 July 2023

Article published online:
27 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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