[Angioplasty in risk patients. Possibilities in advanced chronic arterial obstructive diseases (author's transl)].

In vascular diseases in which standardized methods cannot be applied in spite of clear indication, operative treatment is problematic. In the meantime, "extra-anatomic bypasses" have proved useful, being implantable also in patients with high operative risk. The surgical mortality in these patients is about 4% after implantation of an axillo-femoral bypass. The preoperative condition is improved by the extraanatomical bypass, a threatened extremity being retained in about 80%. The late results show a patency rate of 38% and are therefore far below those of the standardized procedure. The results of the femoro-femoral cross-over bypass are better here. The late results in this case with a patency rate of ca. 80% are only slightly worse than with the standard methods. The results of the "extrathoracal bypasses" with a patency rate after 5 years of 92% and a mortality of 0% is more favorable. This is the method of choice.