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.
Schlüsselwörter
Gehtraining - Thrombozytenaggregationshemmer - Lipidsenker - Raucherentwöhnung
Keywords
walking training - platelet aggregation inhibitors - lipid-lowering drugs - smoking
cessation
