Offene Chirurgie der aortoiliakalen Strombahn zur Behandlung der PAVK
Rother U, Meyer A (2024)
Publication Type: Journal article
Publication year: 2024
Journal
DOI: 10.1007/s00772-024-01168-8
Abstract
In the aortoiliac segment an increased use of endovascular strategies can be observed; however, in the case of extensive lesions (Transatlantic Inter-society Consensus, TASC II C and D), open aortic surgery still represents an essential pillar of treatment. Prior to open surgery, computed tomography (CT) angiography of the aorta is meaningful to evaluate the degree of calcification and the exact position of the segment for clamping. Recent meta-analyses showed a clear advantage of open surgery in terms of primary patency (5-year patency rates > 90%), whereas in-hospital mortality showed no significant differences compared to endovascular treatment (1.4% vs. 2.9%, p = 0.242). With respect to the surgical access route transperitoneal or retroperitoneal options are available. For transperitoneal transverse laparotomy with open aortic surgery there are indications for a faster convalescence and less bowel motility disorders. The proximal anastomosis of an aortobifemoral/bi-iliac graft can be done piggyback style either in an end-to-end or end-to-side fashion. Due to possibly better hemodynamics, end-to-end anastomoses result in fewer graft occlusions and less major amputations in long-term follow-up (primary patency 87.5% vs. 90.2%; p < 0.01). In the case of antegrade inflow into the internal iliac artery an end-to-side configuration should be considered. New promising procedures using intraoperative indocyanine green perfusion measurements of bowel perfusion are available in open surgery and can further reduce the operative risk and avoid complications in the future. Decisions on the indications should be made individually in an interdisciplinary vascular board. Patients with extensive aortoiliac arteriosclerosis fit for surgery could benefit in the long-term from an open surgery first strategy.
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Germany (DE)How to cite
APA:
Rother, U., & Meyer, A. (2024). Offene Chirurgie der aortoiliakalen Strombahn zur Behandlung der PAVK. Gefässchirurgie. https://doi.org/10.1007/s00772-024-01168-8
MLA:
Rother, Ulrich, and Alexander Meyer. "Offene Chirurgie der aortoiliakalen Strombahn zur Behandlung der PAVK." Gefässchirurgie (2024).
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