Sind TASC-Kriterien in der Diagnostik und Therapie der pAVK noch relevant?

Zusammenfassung

Der rasende Fortschritt insbesondere der interventionellen Therapie der pAVK erfordert eine Überarbeitung und Revision der geltenden Richtlinien (TASC Recommendations 2000). Die Therapieoptionen unterliegen einer ständigen Weiterentwicklung, so dass Empfehlungen zum Zeitpunkt der Veröffentlichung vielfach nicht mehr dem aktuellen Stand entsprechen. Unter Berücksichtigung der europaweiten Zahlen für operative und interventionelle Prozeduren wird ein Trend zu weniger operativen Eingriffen deutlich. Konsensus-Papiere wie die Charing-Cross-Empfehlungen 2005 und neu veröffentlichte amerikanische Richtlinien (ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease 2005) spiegeln diese Entwicklung wider. Die interventionelle Therapie ist ungeachtet der Komplexität Therapieansatz der ersten Wahl. Eine z. B. jährliche Anpassung geltender Konsensus-Papiere wäre sinnvoll, um aktuelle Entwicklungen abbilden zu können. Die moderne Bildgebung hat im diagnostischen Stufenschema an Bedeutung gewonnen. Goldstandard bleibt in der Diagnostik der AVK neben dem ABI und der Laufbanduntersuchung die Duplexsonographie.

Summary

With regards to the rapid progress of interventional therapy in the treatment of PAOD the revision of the published guidelines (TASC Recommendations 2000) is more than necessary. The current options in therapy are modified constantly. Therefore, published recommendations might be not up-to-date. In consideration of the number of interventions and operations which are performed throughout Europe a trend towards less invasive treatment becomes apparent. Guidelines and recommendations from the Charing Cross and the ACC/ AHA (ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease 2005) are reflecting this development. Regardless of the complexity of the planned procedure interventional treatment is almost always first choice therapy. A yearly revision of the actual guidelines would be useful, leading to an up-to-date modality. Although in the diagnostic pathway MRI and CTA gain more importance, the gold standard in diagnosis of PAOD remains the standardised measurement of the walking capacity, ankle-brachial index (ABI) and duplex ultrasound.

Schlüsselwörter

Behandlungsrichtlinien - pAVK - ACC/AHA-Leitlinien - Interventionen

Keywords

PAOD - guidelines - Charing Cross Consensus - ACC/AHA Guidelines - interventions

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