Interventionen an infrainguinalen Bypässen

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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