Rofo 2010; 182(9): 755-763
DOI: 10.1055/s-0029-1245501
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Endovaskuläre Therapieoptionen bei femoropoplitealer pAVK

Endovascular Therapy Options in Femoro-Popliteal PADK. Brechtel1
  • 1Dept. für diagnostische und interventionelle Radiologie, Universitätsklinik Tübingen
Further Information

Publication History

eingereicht: 12.2.2010

angenommen: 13.5.2010

Publication Date:
05 July 2010 (online)

Zusammenfassung

Die femoropopliteale pAVK stellt weiterhin eine Herausforderung in der endovaskulären Behandlung dar. Die Zahl an endovaskulären femoropoplitealen Eingriffen nimmt stetig zu. Trotz neuer technischer Entwicklungen steht eine dauerhafte Behandlung noch immer aus. Die Entwicklung der minimalisierten Systeme schreitet weiter voran. Hierzu zählen insbesondere diejenigen Verfahren, die eine mechanische Behandlung mit einer Medikamentenapplikation kombinieren. Des Weiteren zeigen sich alte und neue Trends, wie die Atherektomie, die weiter verbessert werden und eine Behandlungsoption darstellen. Dieser Übersichtsartikel soll zunächst die Indikationen zur endovaskulären Behandlung darstellen und im weiteren die zur Zeit etablierten und modernen Behandlungstechniken beleuchten.

Abstract

The endovascular treatment of femoro-popliteal PAD is still challenging. The number of endovascular procedures in this vessel segment has increased over the past years. Despite new technologies, the outcome of endovascular therapy in terms of durability is still weak. In the meantime, the latest developments are progressing, such as the combination of mechanical angioplasty and drug delivery. Additionally, there are former techniques, such as debulking by atherectomy, which have been technically improved and now contribute to modern concepts of endovascular treatment. This article provides an overview on treatment indications and technical options including the latest technical developments.

Literatur

  • 1 McDaniel M D, Cronenwett J L. Basic data related to the natural history of intermittent claudication.  Ann Vasc Surg. 1989;  3 273-277
  • 2 Weitz J I, Byrne J, Clagett G P et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review.  Circulation. 1996;  94 3026-3049
  • 3 Dormandy J, Mahir M, Ascady G et al. Fate of the patient with chronic leg ischaemia. A review article.  J Cardiovasc Surg (Torino). 1989;  30 50-57
  • 4 Norgren L, Hiatt W R, Dormandy J A et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).  Eur J Vasc Endovasc Surg. 2007;  33 S1-S75
  • 5 Hirsch A T, Haskal Z J, Hertzer N R et al. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease) – summary of recommendations.  J Vasc Interv Radiol. 2006;  17 1383-1397 ; quiz 1398
  • 6 Hirsch A T, Haskal Z J, Hertzer N R et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, National Heart, Lung, and Blood Institute, Society for Vascular Nursing, TransAtlantic Inter-Society Consensus and Vascular Disease Foundation.  Circulation. 2006;  113 e463-e654
  • 7 Jonker F HW, Schloesser F JV, Moll F L et al. Dynamic forces in the SFA and popliteal artery during knee flexion. Consequences of stress to consider for stent durability and design.  Endovascular Today. 2008;  5 53-58
  • 8 Zeller T. Current state of endovascular treatment of femoro-popliteal artery disease.  Vasc Med. 2007;  12 223-234
  • 9 Noory E, Rastan A, Schwarzwalder U et al. Retrograde transpopliteal recanalization of chronic superficial femoral artery occlusion after failed re-entry during antegrade subintimal angioplasty.  J Endovasc Ther. 2009;  16 619-623
  • 10 Wiesinger B, Steinkamp H, Konig C et al. Technical report and preliminary clinical data of a novel catheter for luminal re-entry after subintimal dissection.  Invest Radiol. 2005;  40 725-728
  • 11 Dotter C T, Judkins M P. Transluminal Treatment of Arteriosclerotic Obstruction. Description of a New Technic and a Preliminary Report of Its Application.  Circulation. 1964;  30 654-670
  • 12 Bown M J, Bolia A, Sutton A J. Subintimal angioplasty: meta-analytical evidence of clinical utility.  Eur J Vasc Endovasc Surg. 2009;  38 323-337
  • 13 Charalambous N, Schafer P J, Trentmann J et al. Percutaneous Intraluminal Recanalization of Long, Chronic Superficial Femoral and Popliteal Occlusions Using the Frontrunner XP CTO Device: A Single-Center Experience.  Cardiovasc Intervent Radiol. 2010;  33 25-33
  • 14 Al-Ameri H, Shin V, Mayeda G S et al. Peripheral chronic total occlusions treated with subintimal angioplasty and a true lumen re-entry device.  J Invasive Cardiol. 2009;  21 468-472
  • 15 Al-Ameri H, Mayeda G S, Shavelle D M. Use of high-frequency vibrational energy in the treatment of peripheral chronic total occlusions.  Catheter Cardiovasc Interv. 2009;  74 1110-1115
  • 16 Husmann M, Federer J, Keo H H et al. Bailout revascularization of chronic femoral artery occlusions with the new outback catheter following failed conventional endovascular intervention.  J Endovasc Ther. 2009;  16 206-212
  • 17 Kickuth R, Ludwig K C, Do D D et al. Steuerung der Interventionen bei subintimaler Rekanalisation und Fenestration von Dissektionsmembranen durch einen neuartigen zweilumigen intravaskulären Ultraschallkatheter.  Fortschr Röntgenstr. 2006;  178 898-905
  • 18 Scheinert D, Braunlich S, Scheinert S et al. Initial clinical experience with an IVUS-guided transmembrane puncture device to facilitate recanalization of total femoral artery occlusions.  EuroIntervention. 2005;  1 115-119
  • 19 Clark T W, Groffsky J L, Soulen M C. Predictors of long-term patency after femoropopliteal angioplasty: results from the STAR registry.  J Vasc Interv Radiol. 2001;  12 923-933
  • 20 Sabeti S, Schillinger M, Amighi J et al. Primary patency of femoropopliteal arteries treated with nitinol versus stainless steel self-expanding stents: propensity score-adjusted analysis.  Radiology. 2004;  232 516-521
  • 21 Scheinert D, Scheinert S, Sax J et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting.  J Am Coll Cardiol. 2005;  45 312-315
  • 22 Zeller T, Tiefenbacher C, Steinkamp H J et al. Nitinol stent implantation in TASC A and B superficial femoral artery lesions: the Femoral Artery Conformexx Trial (FACT).  J Endovasc Ther. 2008;  15 390-398
  • 23 Krankenberg H, Schluter M, Steinkamp H J et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST).  Circulation. 2007;  116 285-292
  • 24 Dick P, Wallner H, Sabeti S et al. Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions.  Catheter Cardiovasc Interv. 2009;  74 1090-1095
  • 25 Schillinger M, Sabeti S, Loewe C et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery.  N Engl J Med. 2006;  354 1879-1888
  • 26 Bischoff B. RESILIENT II-1-Jahres-Ergebnisse. Randomisierte Studie zum Vergleich alleiniger PTA versus PTA plus LifeStent bei Stenosen der A. femoralis superficialis und der proximalen A. poplitea.  Herz. 2008;  33 313
  • 27 Bosiers M, Torsello G, Gissler H M et al. Nitinol stent implantation in long superficial femoral artery lesions: 12-month results of the DURABILITY I study.  J Endovasc Ther. 2009;  16 261-269
  • 28 Berceli S A. Revision of vein bypass grafts: factors affecting durability of interventions.  Semin Vasc Surg. 2009;  22 261-266
  • 29 Cotroneo A R, Iezzi R. The Role of ”Cutting” Balloon Angioplasty for the Treatment of Short Femoral Bifurcation Steno-Obstructive Disease.  Cardiovasc Intervent Radiol. 2010;  epub ahead of print, PMID: 20098989
  • 30 Speck U, Scheller B, Abramjuk C et al. Neointima inhibition: comparison of effectiveness of non-stent-based local drug delivery and a drug-eluting stent in porcine coronary arteries.  Radiology. 2006;  240 411-418
  • 31 Scheller B, Hehrlein C, Bocksch W et al. Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter.  N Engl J Med. 2006;  355 2113-2124
  • 32 Tepe G, Zeller T, Albrecht T et al. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg.  N Engl J Med. 2008;  358 689-699
  • 33 Duda S H, Bosiers M, Lammer J et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial.  J Vasc Interv Radiol. 2005;  16 331-338
  • 34 Duda S H, Bosiers M, Lammer J et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial.  J Endovasc Ther. 2006;  13 701-710
  • 35 Bosiers M, Deloose K, Keirse K et al. Are drug-eluting stents the future of SFA treatment?.  J Cardiovasc Surg. 2010;  51 115-119
  • 36 Ahmadi R, Schillinger M, Maca T et al. Femoropopliteal arteries: immediate and long-term results with a Dacron-covered stent-graft.  Radiology. 2002;  223 345-350
  • 37 Saxon R R, Dake M D, Volgelzang R L et al. Randomized, multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease.  J Vasc Interv Radiol. 2008;  19 823-832
  • 38 Jahnke T, Andresen R, Muller-Hulsbeck S et al. Hemobahn stent-grafts for treatment of femoropopliteal arterial obstructions: midterm results of a prospective trial.  J Vasc Interv Radiol. 2003;  14 41-51
  • 39 Saxon R R, Coffman J M, Gooding J M et al. Long-term patency and clinical outcome of the Viabahn stent-graft for femoropopliteal artery obstructions.  J Vasc Interv Radiol. 2007;  18 1341-1349 ; quiz 1350
  • 40 Waksman R, Laird J R, Jurkovitz C T et al. Intravascular radiation therapy after balloon angioplasty of narrowed femoropopliteal arteries to prevent restenosis: results of the PARIS feasibility clinical trial.  J Vasc Interv Radiol. 2001;  12 915-921
  • 41 Gallino A, Do D D, Alerci M et al. Effects of probucol versus aspirin and versus brachytherapy on restenosis after femoropopliteal angioplasty: the PAB randomized multicenter trial.  J Endovasc Ther. 2004;  11 595-604
  • 42 Wolfram R M, Budinsky A C, Pokrajac B et al. Vascular brachytherapy with 192Ir after femoropopliteal stent implantation in high-risk patients: twelve-month follow-up results from the Vienna-5 trial.  Radiology. 2005;  236 343-351
  • 43 Wolfram R M, Budinsky A C, Pokrajac B et al. Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty: five-year follow-up--prospective randomized study.  Radiology. 2006;  240 878-884
  • 44 Kehlbach R, Dittmann H, Schmid T et al. Early effects of rhenium-188 treatment on proliferation, migration, and matrix synthesis of cultured human aortic smooth muscle cells.  Strahlenther Onkol. 2006;  182 164-171
  • 45 Henning E, Dittmann H, Wiskirchen J et al. Dosisabhängige Auswirkungen des kombinierten beta-gamma-Emitters 188Rhenium auf humane Endothelzellen und humane vaskuläre glatte Muskelzellen.  Fortschr Röntgenstr. 2004;  176 404-408
  • 46 Ahn S S. Infrainguinal atherectomy using the Auth Rotablator.  J Endovasc Surg. 1995;  2 317-319
  • 47 Tielbeek A V, Vroegindeweij D, Buth J et al. Comparison of balloon angioplasty and Simpson atherectomy for lesions in the femoropopliteal artery: angiographic and clinical results of a prospective randomized trial.  J Vasc Interv Radiol. 1996;  7 837-844
  • 48 Vroegindeweij D, Tielbeek A V, Buth J et al. Directional atherectomy versus balloon angioplasty in segmental femoropopliteal artery disease: two-year follow-up with color-flow duplex scanning.  J Vasc Surg. 1995;  21 255-268 ; discussion 268 – 259
  • 49 Ramaiah V, Gammon R, Kiesz S et al. Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection.  J Endovasc Ther. 2006;  13 592-602
  • 50 Zeller T, Rastan A, Sixt S et al. Long-term results after directional atherectomy of femoro-popliteal lesions.  J Am Coll Cardiol. 2006;  48 1573-1578
  • 51 Schwarzwälder U, Zeller T. Debulking Procedures: Potential Device Specific Indications.  Tech Vasc Interv Radiol. 2010;  13 43-53
  • 52 Wissgott C, Kamusella P, Richter A et al. Behandlung von Lasionen der femoropoplitealen Arterien mittels eines neuartigen Rotationsatherektomiesystems: Erste single-center Erfahrungen mit dem Pathway PVTM Atherectomy System.  Fortschr Röntgenstr. 2008;  180 809-815
  • 53 Zeller T, Krankenberg H, Rastan A et al. Percutaneous rotational and aspiration atherectomy in infrainguinal peripheral arterial occlusive disease: a multicenter pilot study.  J Endovasc Ther. 2007;  14 357-364
  • 54 Zeller T, Krankenberg H, Steinkamp H et al. One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial.  J Endovasc Ther. 2009;  16 653-662
  • 55 Laird J R, Reiser Jr C, Biamino G et al. Excimer laser assisted angioplasty for the treatment of critical limb ischemia.  J Cardiovasc Surg. 2004;  45 239-248
  • 56 Das T S. Excimer laser-assisted angioplasty for infrainguinal artery disease.  J Endovasc Ther. 2009;  16 II98-104
  • 57 Scheinert D, Laird J R, Schroder Jr M et al. Excimer laser-assisted recanalization of long, chronic superficial femoral artery occlusions.  J Endovasc Ther. 2001;  8 156-166
  • 58 Laird J R, Zeller T, Gray B H et al. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial.  J Endovasc Ther. 2006;  13 1-11

Klaus Brechtel

Dept. für diagnostische und interventionelle Radiologie, Universitätsklinik Tübingen

Hoppe-Seyler-Str. 3

72076 Tübingen

Phone: ++ 49/70 71/2 98 20 87

Fax: ++ 49/70 71/29 59 41

Email: klaus.brechtel@med.uni-tuebingen.de

    >