Die rekonstruktive chirurgische Behandlung des chronischen Aorta-Ilica-Verschlusses

Heberer, G.; Bonhoeffer, K. F.; Rau, G.

doi:10.1007/bf01438490

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…Bei der insgesamt doch hohen postoperativen Letalit~itsrate sind die Kriterien der allgemeinen Operabilit~it bei Wiederherstellungsoperationen im aorto-iliacalen Abschnitt besonders streng zu i.iberpr/ifen [1,4,9,10,14,15,21,23]. Bei den Thrombendarteriektomierten handelt es sich in der Regel um jiingere Kranke mit weniger ausgedehnten Verschl/issen.…”

Section: Eliskussionunclassified

Zur Wahl des Operationsverfahrens im aorto-iliacalen Gef��abschnitt Erfahrungsbericht �ber 1080 Rekonstruktionen

Schulz

Laubach

Preißler

1977

Langenbecks Arch Chiv

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An analysis has been made in 1080 aorto-iliac reconstructions performed from 1959 through 1974 at the Department of Surgery, University of Heidelberg. The ages of 1071 patients ranged from 20--97 with an average of 54.2 years. The ratio of men to women was 19 to 1. The predominant underlying lesion was atherosclerosis in 87.9 %. The choice of reconstructive procedure is dictated by the nature and extent of the occlusive process beside certain systemic factors. Morphologic characteristics allow the classification into 4 categories of aorto-iliac obliterations: Segmental occlusions (type I, 44 %), diffuse involvement of the iliac arteries and the terminal aorta (type II, 30 %); limitation of the lesion to the bifurcation (type III, 17%); propagation of the process towards the renal arteries (type IV, 9%). From 1959 through 1965 dacron bypass grafting was the most frequently employed procedure. Since 1961 a small number of endarterectomies was carried out. Since 1966 endarterectomy was used in a rising number of cases and has become the most common type of aorto-iliac recontruction in the last 4 years. The indication for endarterectomy is restricted to segmental occlusions (type I), to lesions of the bifurcation (type III) and in younger patients to diffuse obliterations of the iliac arteries and the terminal aorta (type II). The dacron bypass graft is the method of choice in the greater part of diffuse lesions (type II) and in aortic occlusions up to the renal arteries (type IV). Endarterectomy was performed in 478, bilateral bypass grafting in 530 and unilateral bypass grafting in 72 cases. Stage II, i.e. intermittent claudication, was the indication in 77%, stage III and IV, i.e. resting pain and gangrene, in 23% of all reconstructions. Associated occlusive disease of the femoropopliteal arteries was present in 62 %. The over-all operative mortality was 6.8%. For all the series endarterectomy showed a patency rate of 90.7%, bilateral bypass grafts of 92.2%, and unilateral bypass grafts of 77.2%. Accumulative patency rates by the life table method do not show statistically significant differences between endarterectomy and bilateral 42 U. Schulz et al. bypass grafts. Our preference for endarterectomy over bypass procedures in recent years seems also to be justified by the uncertain fate of the prostheses and their incorporation.

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Section: Eliskussionunclassified

Zur Wahl des Operationsverfahrens im aorto-iliacalen Gef��abschnitt Erfahrungsbericht �ber 1080 Rekonstruktionen

Schulz

Laubach

Preißler

1977

Langenbecks Arch Chiv

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“…Obliterierende Spätthrombosen treten zudem auch häufig bei alloplastischem Gefäßersatz, wie Nylon, Teflon-u. a. Prothesen mit kleinem Kaliber auf (5,7,9). Wenn die Probleme der Host-Versus-Graft-Reaktion beherrscht werden könnten, wäre homologes, also biologisches Material der optimale Ersatz für Gefäße aller Kaliber; es wäre sogar jedem Prothesenmaterial überlegen.…”

Section: Diskussionunclassified

Bedeutung der immunosuppressiven Therapie bei homologem Gefäßersatz *

Ts¹,

Nagel²,

Bechtelsheimer³

et al. 1971

Thorac cardiovasc Surg

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Deshalb fand in den beiden letzten Jahrzehnten der alloplastische Gefäßersatz, z. B. durch Nylon-, Teflon-, Dacron-und andere Prothesen, enthusiastische Aufnahme. Leider zeigten sich auch hierbei mitunter Nachteile, z. B. mangelhafte Endothelbildung (Thrombosegefahr!), hyaline Degeneration der biologischen Wandteile, Fremdkörperreaktionen, Verkalkungen, Hämatombildungen und Rupturen. Besonders für kleinkalibrige Arterien waren Kunststoffprothesen nicht geeignet

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