Zusammenfassung
Einleitung: Die klinischen Resultate nach kombinierter infrainguinaler Bypassthrombektomie und Angioplastie der peripheren Ausstrombahn werden dargestellt. Der Einfluss verschiedener Parameter auf Beinerhalt sowie primäre und sekundäre Offenheitsrate werden evaluiert. Patienten und Methode: Von Januar 2001 bis März 2005 wurden 49 Angioplastien wegen Stenosen/Verschlüssen der distalen Anastomose bzw. der Ausstrombahn bei verschlossenem infrainguinalem Bypass durchgeführt (23 Männer und 16 Frauen, mittleres Alter 71,1 Jahre). Es handelte sich überwiegend um High-risk-Patienten. 20 Angioplastien betrafen die abführenden Arterien, fünf die distale Anastomose und 24 beide Lokalisationen 11,3 Monate (2-85 Monate) post operationem. 20 Bypässe waren oberhalb des Kniegelenkes, 21 unterhalb des Kniegelenks mit der A. poplitea und 8 auf eine krurale Arterie erfolgt. Ergebnisse: Die Kaplan-Meier-Analyse zeigte eine kumulative Beinerhaltungsrate von 87,0 bzw. 76,4 % nach sechs Monaten bzw. zwei Jahren. Patienten mit Gangrän hatten ein fünffach höheres Amputationsrisiko (Cox-regression model). Primäre und sekundäre Offenheitsrate betrugen nach sechs Monaten 85,1 bzw. 91,1 % und nach einem Jahr 73,3 bzw. 78,8 %. Patienten mit terminaler Niereninsuffizienz waren vierfach mehr gefährdet für einen primären Re-Gefäßverschluss und Patienten mit Gangrän erlitten einen fünffach häufigeren sekundären Gefäßverschluss (Cox-regression model). Schlussfolgerungen: Auch wenn die Ergebnisse der Angioplastie der peripheren Ausstrombahn an Anastomose und/oder abführenden Arterien im Vergleich zu den gefäßchirurgischen Revisionen nach der Literatur ungünstiger liegen, ist dennoch bei High-risk-Patienten zumal bei Abwesenheit einer Vene dieses Vorgehen die erste Alternative zum Beinerhalt.
Abstract
Background: We investigated the clinical results of transluminal angioplasty performed through infrainguinal bypass grafts for stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in high risk patients and the influence of different parameters on limb salvage, primary and secondary patency rate. Patients and methods: Between January 2001 and March 2005 we performed 49 transluminal angioplasties on stenotic or occlusive lesions at the distal anastomosis and/or in the runoff arteries in 49 (16 female, 23 male, mean age 71.1 years) patients with occluded infrainguinal bypass. 20 angioplasties occurred in the runoff arteries, 5 at the distal anstomosis and 24 at both locations at a median of 11.3 months (range 2-85 months) after infrainguinal bypass grafting). 20 procedures were on popliteal artery above the knee, 21 below the knee and 8 on crural arteries. Results: Kaplan-Meier analysis showed a cumulative limb salvage of 87.6 and 76.4 % after 6 months and two years, respectively. Patients with gangrenous lesions had a 5 times higher risk of amputation (Cox-regression model). Primary and secondary patency rates were at 6 months 85.1 and 91.1 % respectively and were at one year 73.3 and 78.8 % respectively. Patients with end stage renal disease were in 4 times hazard to primary occlusion and patients with gagrenous lesions 5 times to secondary occlusion (Cox-regression model). Conclusion: Even if the long-term results of angioplasty on stenotic or occluded lesions at the distal anastomosis and/or in the runoff arteries are inferior to the results of surgical revisions reported in literature, angioplasty in high risk patients with absence af a vein may be the first line alternative intervention for limb salvage.
Schlüsselwörter
infrainguinaler Bypassverschluss - Bypassthrombektomie - Angioplastie - kombiniertes Verfahren
Key words
infrainguinal bypass occlusion - bypass thrombectomy - angioplasty - combined procedure
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Dr. med. F. Sigala
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