Wo steht der pedale Bypass heute? View Full Text


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Article Info

DATE

2018-02

AUTHORS

Richard Kellersmann

ABSTRACT

Seit mehreren Jahrzehnten stellt der autologe Venenbypass auf Arterien des Fußes eine wichtige Option zum Extremitätenerhalt bei chronisch kritischer Extremitätenischämie, insbesondere beim Diabetiker dar. 1‑Jahres-Offenheitsraten von 50–80 % und Beinerhaltungsraten von >80 % haben die Effektivität dieser periphersten Form der chirurgischen Gefäßrekonstruktion unterstrichen. Die zunehmenden Möglichkeiten der endovaskulären Behandlung von Stenosen und Okklusionen der Unterschenkelarterien haben die Rolle des pedalen Bypasses deutlich zurückgedrängt. Die geringere Invasivität mit mutmaßlich reduzierter Morbidität und Letalität lassen perkutane Angioplastien in dieser Indikation primär attraktiver erscheinen. Dennoch zeigen gerade neuere Untersuchungen, dass die primäre Revaskularisation des Fußes durch einen Bypass („straight line to the foot“) eine effektivere und durablere Abheilung von Fußwunden zu ermöglichen scheint. Die Einhaltung des Angiosom-Konzepts spielt dabei jedoch im Vergleich zur endovaskulären Therapie wahrscheinlich eine geringere Rolle. Diagnostische Verfahren wie die Duplexsonographie und die kontrastmittelverstärkte Magnetresonanzangiographie können wichtige ergänzende Verfahren zur Detektion anschlussfähiger Fußarterien sein. Neben der V. saphena magna kommen alternative, autologe Bypassgrafts wie Armvenen und die V. saphena parva in Betracht. Eine langfristige Überwachung der Funktion der pedalen Bypässe wird immer wieder empfohlen. Um auch zukünftig den Stellenwert dieser wichtigen Option zur Behandlung einer chronisch kritischen Extremitätenischämie bewerten zu können, sind dringend weitere Studien erforderlich. More... »

PAGES

13-18

Journal

TITLE

Gefässchirurgie

ISSUE

1

VOLUME

23

Author Affiliations

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00772-017-0350-z

DOI

http://dx.doi.org/10.1007/s00772-017-0350-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1100617717


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60 schema:description Seit mehreren Jahrzehnten stellt der autologe Venenbypass auf Arterien des Fußes eine wichtige Option zum Extremitätenerhalt bei chronisch kritischer Extremitätenischämie, insbesondere beim Diabetiker dar. 1‑Jahres-Offenheitsraten von 50–80 % und Beinerhaltungsraten von >80 % haben die Effektivität dieser periphersten Form der chirurgischen Gefäßrekonstruktion unterstrichen. Die zunehmenden Möglichkeiten der endovaskulären Behandlung von Stenosen und Okklusionen der Unterschenkelarterien haben die Rolle des pedalen Bypasses deutlich zurückgedrängt. Die geringere Invasivität mit mutmaßlich reduzierter Morbidität und Letalität lassen perkutane Angioplastien in dieser Indikation primär attraktiver erscheinen. Dennoch zeigen gerade neuere Untersuchungen, dass die primäre Revaskularisation des Fußes durch einen Bypass („straight line to the foot“) eine effektivere und durablere Abheilung von Fußwunden zu ermöglichen scheint. Die Einhaltung des Angiosom-Konzepts spielt dabei jedoch im Vergleich zur endovaskulären Therapie wahrscheinlich eine geringere Rolle. Diagnostische Verfahren wie die Duplexsonographie und die kontrastmittelverstärkte Magnetresonanzangiographie können wichtige ergänzende Verfahren zur Detektion anschlussfähiger Fußarterien sein. Neben der V. saphena magna kommen alternative, autologe Bypassgrafts wie Armvenen und die V. saphena parva in Betracht. Eine langfristige Überwachung der Funktion der pedalen Bypässe wird immer wieder empfohlen. Um auch zukünftig den Stellenwert dieser wichtigen Option zur Behandlung einer chronisch kritischen Extremitätenischämie bewerten zu können, sind dringend weitere Studien erforderlich.
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