Neueste Entwicklungen bei peripheren Interventionen – Klassisch versus endovaskulär

Die endovaskuläre Therapie hat in den letzten Jahren bei der Behandlung der PAVK der unteren Extremität wesentlich an Bedeutung gewonnen. Im Beckenbereich ist die stentgestützte Angioplastie vielerorts prinzipiell Therapie der ersten Wahl geworden. Die A. femoralis superficialis ist dank neuartiger Techniken fast immer erfolgreich rekanalisierbar. Mit verschiedensten neuen Stent-Technologien, Paclitaxel freisetzenden Stents sowie mit Paclitaxel beschichteten Ballons wird versucht, der hohen Restenoserate entgegen zu wirken. Für den Unterschenkel sind Ballons entwickelt worden, mit denen auch langstreckige Obstruktionen behandelt werden können. Auch infrapopliteal sind Medikamente freisetzende Systeme Gegenstand klinischer Untersuchungen, erste Ergebnisse sind vielversprechend.

During the last years endovascular therapy became increasingly important for the treatment of lower limb arteriosclerotic disease. Balloon-angioplasty and stenting is usually the first option for iliac obstructions. The superficial femoral artery, often presenting with severe calcification and total occlusions, can be recanalized in a very high proportion of cases due to the introduction of new technologies and stent-systems appropriate to meet the challenges of severe calcification. Paclitaxel eluting stents and paclitaxel coated balloons have shown promising results in first studies and may play a major role in the future to reduce the high rate of restenosis. Infrapopliteal angioplasty has become first choice treatment in an increasing number of centres even for long tibial obstructions. Drug-eluting stents and drug-coated balloons are currently tested also in this arterial segment and first results are promising.

Key words

Percutaneous transluminal angioplasty - interventional therapy - restenosis - drug-eluting stent - drug-coated balloon

• Literatur

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