Arterielle Verschlusskrankheit der Becken- und Oberschenkelarterien

Abstract

Endoluminal therapy is indicated in lower extremity ischaemia with Fontaine grades IIb, III and IV. In the presence of significant limitations, interventions are carried out even in grade IIa claudicants. In addition to the TASC A and B lesions, TASC C and D lesions are increasingly being treated endoluminally as well. Presently, technical success rates of revascularization procedures are above 90% in the iliac vessels and between 79% and 95% in the femoro-popliteal segments. Concentric, non-calcified iliac stenoses are primarily treated with balloon angioplasty (PTA) followed by optional stenting when necessary. For occlusions and heavily calcified lesions, primary stenting is recommended. Primary PTA is the mainstay of treatment in femoro-popliteal vessels with stents being used as a "bail-out" option in case of suboptimal PTA. However, initial reports proving the superiority of primary stenting over PTA with optional stenting have already appeared. Results of PTA with drug-coated balloons for prevention of early restenosis are promising. In the near future, primary PTA with optional stenting in the femoro-popliteal segments may give way to drug-coated balloon angioplasty or primary stenting.