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Die akute Extremitätenischämie

Clinical pathways—wann operieren, wann interventionell behandeln

Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Vorgehensweise zur Erhaltung der ischämisch bedrohten Extremität wird nach wie vor kontrovers diskutiert. In einer retrospektiven Studie wurden das chirurgisch-interventionelle und das perkutan-interventionelle Vorgehen bei rein embolischen und bei akuten thrombotischen Verschlüssen mit vorbestehenden arteriosklerotischen Veränderungen miteinander verglichen. Die perkutane mechanische Thrombektomie stellt besonders bei weichem, embolischem Verschlussmaterial sowie im infrapoplitealen Bereich eine Therapiealternative zum chirurgischen bzw. chirurgisch-endovaskulären Vorgehen dar. Die interdisziplinäre Indikationsstellung zur jeweiligen Verfahrenswahl sollte sich speziell am klinischen und am angiographischen Befund des einzelnen Patienten orientieren. Zusätzliche intraoperative endovaskuläre Therapieverfahren bieten die Möglichkeit eines erweiterten Aktionsradius und ermöglichen das gezielte Vorgehen sowohl im Zustrom- als auch im Abstromgebiet. Unsere Ergebnisse zeigen klar, dass auch die chirurgische Vorgehensweise sowohl beim embolischen wie insbesondere beim thrombotischen Verschluss alle interventionellen Maßnahmen zur Anwendung bereithalten muss.

Abstract

There is still controversial discussion concerning the therapy of limb-threatening ischaemia. In a retrospective study, we investigated and compared surgical and percutaneous interventional methods in the treatment of both embolic and thrombotic vascular occlusions in patients with pre-existing arteriosclerotic disease and attempted to propose therapy guidelines for these methods in the therapy of acute limb ischaemia. Percutaneous mechanical thrombectomy represents a viable therapeutic alternative to surgical or surgical-interventional modalities, particularly in patients with occlusions consisting of soft, embolic material or located in infrapopliteal vessels. The indication for each respective method should be interdisciplinary and must be based on the individual patients' clinical and angiographic findings. Additional intraoperative endovascular procedures increase the range of therapeutic options and permit optimal revascularisation of vessels both proximal and distal to the site of occlusion.

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Halter, G., Orend, KH. & Sunder-Plassmann, L. Die akute Extremitätenischämie. Chirurg 74, 1118–1127 (2003). https://doi.org/10.1007/s00104-003-0723-6

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  • DOI: https://doi.org/10.1007/s00104-003-0723-6

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