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Periphere arterielle Verschlusskrankheit

Peripheral arterial disease

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Zusammenfassung

Die periphere arterielle Verschlusskrankheit (PAVK) hat eine hohe Prävalenz, und Patienten mit PAVK versterben meist an kardiovaskulären Ereignissen. Die Mehrzahl der Patienten ist klinisch symptomfrei, daher ist ein Screening von Risikopersonen durch Ermittlung des Knöchel-Arm-Index wichtig. In der Diagnostik ist es sinnvoll, funktionelle und morphologische Untersuchungen zu kombinieren, um die Beinperfusion zu beurteilen und eine Therapie zu planen. Bei der Therapie kommt der Einstellung der kardiovaskulären Risikofaktoren eine zentrale Rolle zu, darüber hinaus kommen Thrombozytenaggregationshemmer zum Einsatz. Im Stadium der Claudicatio intermittens ist möglichst ein Gehtraining durchzuführen, daneben stehen Medikamente zur Verbesserung der Gehstrecke zur Verfügung. Eine periphere Intervention kann bei stabiler PAVK indiziert sein, eine operative Behandlung ist in diesem Stadium allerdings Einzelfällen vorbehalten. Im Stadium der kritischen Extremitätenischämie (Ruheschmerz oder Ulkus/Gangrän) sollte jedoch schnellst möglich eine endovaskuläre oder operative Behandlung erfolgen. Auch nach einer erfolgreichen Behandlung der Beinischämie ist eine lebenslange regelmäßige Nachsorge bei diesen Hochrisikopatienten notwendig.

Abstract

Prevalence of peripheral arterial disease (PAD) is high and patients with PAD have a high rate of cardiovascular mortality. Most patients are clinically asymptomatic, therefore it is important to screen persons using ankle-brachial index. It is useful to combine functional and morphological measurements to diagnose leg perfusion and for planning various treatment options. Treatment of cardiovascular risk factors is central to improve prognosis. Moreover, thrombocyte aggregation inhibitors are indicated. Patients with intermittent claudication should perform an exercise training program. In addition drugs can be used to improve walking distance. In patients with intermittent claudication peripheral intervention can be useful. However, in stable patients surgical treatment should be restricted to single cases. In patients with critical limb ischemia (pain at rest or ulcer/gangrene) percutaneous intervention or bypass surgery must be performed immediately. After successful improvement of leg perfusion the high risk PAD patients should be followed by a regular program for all their life.

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Danksagung

Die Autorin dankt Frau Margot Neuser für die graphische Gestaltung der Abb. 5.

Interessenkonflikt

Die korrespondierende Autorin weist auf folgende Beziehungen hin:

Referentenhonorare: Sanofi-Aventis, Bristol Myers Squibb, Pfizer, Berlin-Chemie, Boehringer Ingelheim, UCB Schwarz Pharma Deutschland, Merck.

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  1. II. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    C. Espinola-Klein

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Correspondence to C. Espinola-Klein.

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Espinola-Klein, C. Periphere arterielle Verschlusskrankheit. Internist 52, 549–561 (2011). https://doi.org/10.1007/s00108-011-2814-7

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