Roth F J, Roth S P
Radiologische Abteilung der Aggertalklinik, Engelskirchen.
Z Arztl Fortbild Qualitatssich. 1999 Nov;93(9):659-66.
In the therapy of the chronic peripheral vascular occlusion, angioplasty is rarely used to treat the infra-renal aortic stenosis, whereas the stenosis and the short occlusion of the iliac artery is a classical indication. Primarily, stenoses and occlusions of the iliac artery should be treated with balloon angioplasty exclusively. Only secondarily, when the result of angioplasty was insufficient, e.g. remaining stenosis or dissection, stent implantation is appropriate. Angioplasty is most frequently applied in the obliteration of the femoro-popliteal artery. It can be stated that early- and long-term results are the better, the shorter the occlusion is. Stent implantation in the femoro-popliteal artery should be avoided because of poor results. Only with the intention of limb salvage, when there is no opportunity for surgical treatment, a stent implantation should be considered. In case of recurrent stenoses after stent implantation, angioplasty can be reapplied with great success. The indication for any vascular intervention should be a decision of both, the interventional radiologist and the vascular surgeon, because both kinds of treatment are palliative and not causal. It is the task of the angiologist to do clinical diagnostics and the after-treatment. Quality monitoring is indispensable. It consists of documentation of pre-angioplasty diagnostics and should be able to prove the correct indication for the intervention. The result of the intervention should also be documented by angiography and functional tests. Regular control of the patient after the intervention is necessary for the early recognition of recurrent stenoses.
在慢性周围血管闭塞的治疗中,血管成形术很少用于治疗肾下腹主动脉狭窄,而髂动脉狭窄和短段闭塞是其经典适应证。首先,髂动脉狭窄和闭塞应仅采用球囊血管成形术治疗。只有在血管成形术效果不佳时,例如仍存在狭窄或夹层,才适合植入支架。血管成形术最常用于股腘动脉闭塞。可以说,闭塞时间越短,早期和长期效果越好。由于效果不佳,应避免在股腘动脉植入支架。只有在意图挽救肢体且没有手术治疗机会时,才应考虑植入支架。在支架植入后出现复发性狭窄的情况下,再次进行血管成形术可能会取得巨大成功。任何血管介入治疗的适应证都应由介入放射科医生和血管外科医生共同决定,因为这两种治疗都是姑息性的而非病因性的。血管病医生的任务是进行临床诊断和后续治疗。质量监测不可或缺。它包括血管成形术前诊断的记录,并且应该能够证明干预的正确适应证。干预结果也应由血管造影和功能测试记录。干预后定期对患者进行检查对于早期识别复发性狭窄是必要的。