Kosan J, Riess H, Atlihan G, Diener H, Kölbel T, Debus E S
Klinik für Gefäßmedizin, Gefäßchirurgie - Angiologie - endovaskuläre Therapie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Chirurg. 2014 Sep;85(9):791-9. doi: 10.1007/s00104-014-2720-3.
Occlusion of the aorta and the iliac arteries leads to an insufficient perfusion of the legs and the genital and gluteal region. The occurring symptoms may be variable, mainly depending on the collateralization network of the internal iliac artery (IIA) circulation. Various differential diagnoses need to be excluded. Invasive therapy is almost always inevitable if an aortoiliac stenosis is established. With good patency rates and low mortality rates the indications for reconstructive procedures are liberally interpreted; therefore, invasive therapy can be performed in the early stages of claudication in certain situations. Due to lower invasiveness and therefore lower risk of complications while showing comparable long-term patency rates, endovascular treatment is the preferred first line therapy for the majority of occlusions. Because aortoiliac occlusion processes also affect patients who are actively involved in a professional career, the indications for invasive therapy can be attained even in Fontaine stage IIa.
主动脉及髂动脉闭塞会导致下肢以及生殖器和臀部区域灌注不足。出现的症状可能各不相同,主要取决于髂内动脉(IIA)循环的侧支循环网络。需要排除各种鉴别诊断。如果确诊为主髂动脉狭窄,几乎总是不可避免地需要进行侵入性治疗。由于重建手术的通畅率良好且死亡率较低,其适应症的解读较为宽松;因此,在某些情况下,可在间歇性跛行的早期阶段进行侵入性治疗。由于血管内治疗的侵入性较低,因此并发症风险较低,同时显示出相当的长期通畅率,所以对于大多数闭塞情况,血管内治疗是首选的一线治疗方法。由于主髂动脉闭塞过程也会影响积极从事职业工作的患者,即使在Fontaine IIa期也可达到侵入性治疗的适应症。