Müller-Hülsbeck S
Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein der Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
Radiologe. 2006 Nov;46(11):973-9. doi: 10.1007/s00117-006-1430-3.
In order to obtain optimal results and satisfied patients, rational therapy of pAOD should strictly follow national and international society guidelines. In particular cases an individual therapeutic concept seems justified beyond these guidelines. Based on clinical data and driven by costs, aortic and iliac lesions may be treated by PTA or selective stent placement with equal results; however, long-term data justify also primary, direct stenting. For treatment of infrainguinal and popliteal stenotic lesions primary stenting should be restricted to PTA failure (dissection, recoil, occlusion); except for treatment of extended lesions, primary stenting compared to PTA alone seems beneficial in terms of midterm patency. Endovascular procedures below the knee and at the toe should be limited to existing limb-threatening ischemia in order to save the extremity; whether PTA or stenting is advantageous has not yet determined.
为了获得最佳治疗效果并使患者满意，pAOD的合理治疗应严格遵循国内和国际学会指南。在某些特殊情况下，超出这些指南的个体化治疗方案似乎是合理的。基于临床数据并受成本驱动，主动脉和髂动脉病变可通过经皮腔内血管成形术（PTA）或选择性支架置入术进行治疗，效果相同；然而，长期数据也支持首选直接支架置入术。对于股腘以下狭窄病变的治疗，原发性支架置入术应仅限于PTA失败（夹层、回缩、闭塞）的情况；除了治疗广泛性病变外，与单纯PTA相比，原发性支架置入术在中期通畅率方面似乎更具优势。膝下和足趾部位的血管腔内手术应仅限于存在肢体威胁性缺血的情况，以挽救肢体；PTA或支架置入术哪种更具优势尚未确定。
