Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD) – Current Data and Perspectives

Jonas Kersting; Lars Kamper; Marco Das; Patrick Haage

doi:10.1055/a-0690-9365

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2019; 191(04): 311-322
DOI: 10.1055/a-0690-9365

Review

Leitliniengerechte Therapie der PAVK – Aktuelle Studienlage und Ausblick

Article in several languages: English | deutsch

Jonas Kersting

¹Radiology, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany

,

Lars Kamper

¹Radiology, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany

,

Marco Das

²Radiology, HELIOS Klinikum Duisburg, Germany

,

Patrick Haage

¹Radiology, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany

› Author Affiliations

Abstract

Zusammenfassung

Hintergrund Die periphere arterielle Verschlusskrankheit (PAVK) hat aufgrund des demografischen Wandels eine zunehmende gesundheitsökonomische Relevanz. PAVK-Patienten sind häufig mehrfach vorerkrankt und dementsprechend komplex und interdisziplinär zu behandeln. Der endovaskulär-interventionellen Therapie fällt dank rascher technischer Entwicklungen eine immer zentralere Rolle zu.

Methode Allgemeines Review mit Literaturrecherche, ausgehend von der aktuellen deutschen S3-Leitlinie zur Therapie der PAVK sowie aktuellen internationalen Leitlinien. Im Hinblick auf moderne Therapieverfahren fand die aktuelle Studienlage Berücksichtigung.

Ergebnisse Die Kenntnis aktueller Leitlinien und Handlungsempfehlungen sowie neuer therapeutischer Tendenzen und Ansätze ist essenziell zur suffizienten Behandlung von PAVK-Patienten. Zudem ist eine enge Zusammenarbeit zwischen interventioneller Radiologie und Gefäßchirurgie der Schlüssel zum Erfolg. Neben konservativen Ansätzen und den Bypass-OP-Verfahren haben die endovaskulären Ansätze stark an Bedeutung gewonnen. Diese sind in den PAVK-Stadien TASC A und B seit vielen Jahren Methode der Wahl und zeigen nunmehr vielversprechende Ergebnisse in der Behandlung von diffizilen TASC-C- und -D-Konstellationen. Eine primär endovaskuläre Strategie ist in einer Vielzahl der Fälle leitliniengerecht.

Schlussfolgerung Die primär endovaskuläre Vorgehensweise ist mittlerweile bei der Mehrzahl auch komplexer Läsionen der Becken-Bein-Achse zum Standard geworden. Der endovaskuläre Ansatz zeigt läsionsbezogen gut belegte Vorteile gegenüber der Bypass-Chirurgie, so zum Beispiel im Unterschenkelsegment eine Senkung der Mortalität. Weitere Evidenz wird zukünftig durch mehrere großangelegte randomisierte Multicenterstudien erwartet.

Kernaussagen:

Suffiziente Diagnostik essenziell zur Einordnung und Therapiefindung bei PAVK
Therapieentscheidung idealerweise in interdisziplinärer Fallkonferenz
Ausschöpfung konservativer sowie medikamentöser Therapie vor Intervention im Stadium der intermittierenden Claudicatio
Primär endovaskulärer Ansatz bei supra- und infrainguinalen Läsionen
Zusätzliche Evidenz von kommenden randomisierten Studien zu erwarten

Zitierweise

Kersting J, Kamper L, Das M et al. Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD) – Current Data and Perspectives. Fortschr Röntgenstr 2019; 191: 311 – 322

Key words

aorta - blood vessels - vascular - angiography - angioplasty - arteriosclerosis

Full Text

References

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